Mindfulness-based stress reduction as a novel treatment for interstitial cystitis/bladder pain syndrome: a randomized controlled trial. (Kanter et al. Int Urogynecol J. 2016 Apr 26).

 

Michelle Spicka, DPT
August 3, 2016
Pelvic Physical Therapy Distance Journal Club

Description: Research shows that up to 11% of women are affected by IC/BPS and the disorder may be significantly underdiagnosed; up to 43% of patients with IC/BPS require multimodal therapy.  The underlying pathophysiology of IC/BPS is poorly understood.  In IC/BPS, increased stress is positively correlated with increased pain and up to 80% of IC/BPS patients noted in a previous survey that stress reduction decreased their symptoms. 

Mindfulness-based stress reduction (MBSR) is a complementary alternative medicine-based therapist and is a standardized program including components of meditations and yoga.  MBSR has been successfully employed to treatment chronic pain syndromes and has been used in disorders such as multiple chemical sensitivity, chronic fatigue syndrome, fibromyalgia, various pelvic floor disorders and IBS as well as urinary urgency.

 Method: This randomized controlled trial included women with IC/BPS undergoing first- or second-line therapies.  Women were randomized to continuation of usual care (n=11) or an 8-week mindfulness-based stress reduction (MBSR) class along with usual care (n=9). The standardized course for MBSR included seven 2 hour courses at weekly intervals with an all-day retreat in the 5^th week. These sessions taught meditations, yoga and other relaxation techniques.  In addition to classroom training, MBSR participates were given a four-CD guide to meditation based on the previous work of Jon Kabat-Zinn and a book to assist with home meditation practice.   

Participants (n=20) completed baseline and 8-week post-treatment questionnaires, including the O’Leary-Sant Syndrome Problem Index (OSPI), the visual analog pain scale (VAS), the Short Form Health Survey (SF-12), the Female Sexual Function Index (FSFI) and the Pain Self-Efficacy Questionnaire (FSEQ).  The Global Response Assessment (GRA) was completed post-treatment.

Results:

Eighty-six percent of MBSR participants felt more empowered to control symptoms, and all participants planned to continue MBSR. Five out of 8 patients in the MBSR group felt an improvement in their symptoms after meditation and the same amount indicated that they practiced home meditation after the course with continued improvement. 

Discussion: Among women with a known diagnosis of IC/BPS, the addition of MBSR to usual care resulted in greater global improvement in response to therapy (GRA) as well as OSPI total and problem scores and pain self-efficacy.  MBSR strategies may provide coping mechanisms to deal with IC/BPS symptoms and pain.

Researchers have suggested that the root cause of suffering in chronic pain may be attributable to associated helplessness and/or hopelessness.  MBSR may diminish perceived helplessness associated with the chronic pain of IC/BPS.  The known association of IC/BPS exacerbation with stress supports the plausibility of MBSR as an adjunctive treatment for this condition.
MBSR is a patient-centered treatment that shifts care from time-consuming medical visits to self-initiated care which empowers patients to address their condition with an intervention that they may be able to self-administer for long-term management.

Other research:

1)      Mindfulness meditation improved parasympathetic functions in pregnant women and is a powerful modulator of the sympathetic nervous system during pregnancy. (Muthukrishnan et al. J Clin Diagn Res 2016).

2)      Cognitive-Behavioral Therapy and physical therapy can lead to clinically meaningful improvements in patients with provoked vestibulodynia. (Goldfinger, et al. J Sex Med 2016).

3)      A recent study showed that meditation involves endogenous opioid pathways, mediating its analgesic effect and growing resilient with increasing practice to external suggestion which holds promising therapeutic implications and further elucidate the fine mechanisms involved in human pain modulation. (Sharon et al. Am J Med. 2016).

4)      Quality of life and mindfulness outcomes may improve with mindfulness meditation. (Fox et al. J Reprod Med. 2011).

5)      Chronic stress exposure early in life has been shown to increase the likelihood of pelvic pain later in life and acute stress exposure can induce or increase symptom severity. (Pierce et al. Prog Mol Biol Transl Sci. 2015).

6)      There is a positive correlation between perceived stress levels and urinary incontinence symptoms and its impact on quality of life among OAB patients.  OAB patients reported psychological stress levels that were as high as IC/BPS patients. (Lai et al. BMC Urol. 2015).