Depression and helplessness impact interstitial cystitis/bladder pain syndrome pain over time
Introduction: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a devastating urological chronic pelvic pain condition with an unknown etiology. Evidence-based psychological strategies are becoming more successful for symptom management as we learn more about the targets for intervention. Previous research has established an indirect relationship between depression and pain through catastrophizing, but there have yet to be studies examining the emerging role of emotion regulation in this relationship.
Methods: Women with IC/BPS were recruited from tertiary care clinics in Canada and the U.S. between 2013 and 2018. Patients completed questionnaires, including demographics and scores for pain, depression, catastrophizing, and difficulties in emotion regulation at baseline, six months, and one year. Serial mediation was used to test models of pain, catastrophizing, and depression.
Results: A total of 135 women with IC/BPS completed all three time points. The only significant indirect path was from baseline depression to catastrophizing at six months to pain at one year (b=0.10; confidence interval [CI] 0.0049–0.2520). A followup analysis demonstrated that helplessness was the key factor of catastrophizing driving this relationship (b=0.17; CI 0.0282–0.3826).
Conclusions: Reducing feelings of helplessness and increasing patient feelings of control are important ways to limit the effect of low mood on patient pain experience. De-catastrophizing interventions should be part of the referral strategy for IC/BPS symptom management.
Nickel JC, Shoskes D, Irvine-Bird K. Clinical phenotyping of women with interstitial cystitis/painful bladder syndrome: a key to classification and potentially improved management. J Urol 2009;182:155-60.
Suskind AM, Berry SH, Suttorp MJ, et al. Symptom persistence in a community cohort of women with interstitial cystitis/bladder pain syndrome (IC/BPS): 3-, 6-, 9-, and 12-month follow-up from the RICE cohort. Int Urogynecol J 2014;25:1639-43.
Clemens JQ, Brown SO, Calhoun EA. Mental health diagnoses in patients with interstitial Cystitis/Painful bladder syndrome and chronic Prostatitis/Chronic pelvic pain syndrome: A Case/Control study. J Urol 2008;180:1378-82.
Tripp DA, Nickel JC, Wong J, et al. Mapping of pain phenotypes in female patients with bladder pain syndrome/interstitial cystitis and controls. Eur Urol 2012;62:1188-94.
Naliboff BD, Stephens AJ, Lai HH, et al. Clinical and psychosocial predictors of urological chronic pelvic pain symptom change in 1 year: A prospective study from the MAPP Research Network. J Urol 2017;198:848-57.
Sullivan MJL, Bishop SR, Pivik J. The Pain Catastrophizing Scale: Development and validation. Psychol Assess 1995;7:524-32.
Geisser ME, Robinson ME, Keefe FJ, et al. Catastrophizing, depression and the sensory, affective and evaluative aspects of chronic pain. Pain 1994;59:79-83.
Linton SJ, Bergbom S. Understanding the link between depression and pain. Scand J Pain 2011;2:47-54.
Williams AC, & Shäfer, G. How do we understand depression in people with persistent pain? J Contemp Psychother 2016;46:149-57.
Nickel JC, Tripp DA, Pontari M, et al. Psychosocial phenotyping in women with interstitial cystitis/painful bladder syndrome: a case control study. J Urol 2010;183:167-72.
Katz L, Tripp DA, Carr LK, et al. Understanding pain and coping in women with intersittial cystitis/bladder pain syndrome. BJU International 2017;120:286-92.
Tripp DA, Nickel JC, FitzGerald MP, et al. Sexual functioning, catastrophizing, depression, and pain, as predictors of quality of life in women with interstitial cystitis/painful bladder syndrome. Urology 2009;73:987-92.
Koechlin H, Coakley R, Schechter N, et al. The role of emotion regulation in chronic pain: A systematic literature review. J Psychosom Res 2018;107:38-45.
Linton SJ, Flink IK, Schrooten MGS, et al. Understanding co-occurring emotion and pain: The role of context sensitivity from a transdiagnostic perspective. J Contemp Psychother 2016;46:129-37.
Trindade IA, Ferreira C, Pinto-Gouveia J. The longitudinal effects of emotion regulation on physical and psychological health: A latent growth analysis exploring the role of cognitive fusion in inflammatory bowel disease. Br J Health Psychol 2018;23:171-85.
Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med 2001;16:606-13.
Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. J Psychopathol Behav Assess 2004;26:41-54.
Melzack R. The short-form McGill Pain Questionnaire. Pain 1987;30:191-7.
Hayes AF. Introduction to mediation, moderation, and conditional process anlaysis. New York: Guilford Press, 2018.
Tripp DA. Managing psychosocial correlates of urologic chronic pelvic pain syndromes: Advice from a urology pain psychologist. Can Urol Assoc J 2018;12:S175-S7.
Tripp DA, Nickel JC. The psychology of urologic chronic pelvic pain: A primer for urologists who want to know how to better manage chronic prostatitis and interstitial cystitis. AUA Update Ser 2011;30:385-96.
Tripp DA, Nickel JC, Ross S, et al. Prevalence, symptom impact and predictors of chronic prostatitis-like symptoms in Canadian males aged 16-19 years. BJU International 2009;103:1080-4.
Lazarus RS, Folkman S. Stress, Appraisal, and Coping. New York: Springer Pub. Co., 1984.
Sullivan MJ, Thorn B, Haythornthwaite JA, et al. Theoretical perspectives on the relation between catastrophizing and pain. Clin J Pain 2001;17:52-64.
Severeijns R, Vlaylen JWS, van den Hout MA. Do we need a communal coping model of pain catastrophizing? An alternative explanation. Pain 2004;111:226-9.
Muere A, Tripp DA, Nickel JC, et al. Depression and coping behaviors are key factors in understanding pain in interstitial cystitis/bladder pain syndrome. Pain Manag Nurs 2018.
Clemens JQ, Joyce GF, Wise M, et al. Interstitial Cystitis and Painful Bladder Syndrome. In: MS Litwin, CS Saigal, editors. Urologic Diseases in America; NIH Publication No. 07-5512. Washington, DC: U.S. Government Publishing Office, 2007. pp. 124-54.
You, the Author(s), assign your copyright in and to the Article to the Canadian Urological Association. This means that you may not, without the prior written permission of the CUA:
- Post the Article on any Web site
- Translate or authorize a translation of the Article
- Copy or otherwise reproduce the Article, in any format, beyond what is permitted under Canadian copyright law, or authorize others to do so
- Copy or otherwise reproduce portions of the Article, including tables and figures, beyond what is permitted under Canadian copyright law, or authorize others to do so.
The CUA encourages use for non-commercial educational purposes and will not unreasonably deny any such permission request.
You retain your moral rights in and to the Article. This means that the CUA may not assert its copyright in such a way that would negatively reflect on your reputation or your right to be associated with the Article.
The CUA also requires you to warrant the following:
- That you are the Author(s) and sole owner(s), that the Article is original and unpublished and that you have not previously assigned copyright or granted a licence to any other third party;
- That all individuals who have made a substantive contribution to the article are acknowledged;
- That the Article does not infringe any proprietary right of any third party and that you have received the permissions necessary to include the work of others in the Article; and
- That the Article does not libel or violate the privacy rights of any third party.