Painful Bladder Syndrome (PBS) is a condition of bladder hypersensitivity that has proven resistant todiagnosis and treatment. PBS is symptom-based diagnoses similar to other disorders such as fibromyalgia(FM). Proposed etiologies for PBS are many, and include alterations in bladder component structure andfunction as well as changes in neurological structures related to the bladder. A single type of therapy isunlikely able to treat multiple pathophysiologies. The goal of this grant is to identify clinically relevantsubgroups or separate phenotypes within the broader selection of patients that meet the criteria for PBSwhich would allow for a stratification of patients. In a limited sampling, quantitative sensory testing (QST) ofPBS patients has found there to be a suggestion of two different phenotypes based on cutaneous sensorytesting. Since one of the groups tests in a fashion that is similar to FM patients the following hypothesis isproposed; Patients with the diagnosis of painful bladder syndrome constitute two or more phenotypes thatare distinguished by differential neurophysiological processing of sensory information. Further, thesediffering phenotypes can be predicted by the presence of absence of co-morbidity fibromyalgia. To test thishypothesis, neurophysiological processing will be assessed psychophysically using standard QST measureand neuropsychological questionnaires and neuroanatomically using an intracerebral bloodflow measure -Continuous Arterial Spin Label functional Magnetic Resonance Imaging (CASL-fMRI), an innovativetechnology.
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