There is consistent epidemiologic association between the presence of interstitial cystitis/ painful bladdersyndrome (IC/PBS) and certain somatic syndromes (e.g., fibromyalgia, irritable bowel syndrome, chronicfatigue syndrome) and psychiatric illness (anxiety, depression). While these associations are wellestablished, their clinical significance has not been evaluated. A central hypothesis of this MAPP DiscoverySite proposal is that certain IC/PBS patients have central abnormalities of pain processing. If true, thenpatients with multiple co-morbidities could represent a more severe disease phenotype which would beassociated with worse clinical outcomes. We hypothesize that over four years of study, about 25% ofwomen will have progression of IC/PBS symptoms, and 25% will have symptom regression; and that IC/PBS patients will have a high rate of co-morbid systemic somatic symptoms at baseline (35%), that they willdevelop other regional pain symptoms and syndromes over time, and that these co-morbidities will beassociated with IC/PBS symptom progression. The coexistence of multiple pain syndromes in individualsubjects will reinforce the idea that IC/PBS patients have a central disturbance in pain processing ratherthan a disorder confined to the bladder. We hypothesize that clinic based patients and community womenwho have both sought and not sought urologist care each represent a subset of the women with bladderand other co-morbid symptoms, and that they differ from each other in terms of predominance and severityof co-morbidities and psychosocial characteristics. Using research methods developed by our group as partof the ongoing RAND Interstitial Cystitis Epidemiology (RICE) Study, we propose to recruit and follow acommunity-based probability sample of women with IC/PBS symptoms in Michigan, Indiana and Ohio, andcombine them with a convenience sample of female IC/PBS patients from the University of Michigan urologyclinic. These samples will allow us to assess and follow subjects with various degrees of IC/PBS severity.These methods are easily applied to additional geographic regions, and we propose that this study be doneas a collaborative project with other MAPP Discovery Sites.
Specific Aims :
AIM 1 - To study the naturalhistory of IC/PBS.
AIM 2 - To identify risk factors associated with symptom progression in women with IC/PBS.
AIM 3 - To assess factors associated with healthcare seeking in individuals with IC/PBS symptoms.
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