Robertson Davies:
There is no nonsense so gross that society will not, at some time, make a doctrine of it and defend it with every weapon of communal stupidity.
Doctor Speedy and ME in search of medical honesty
Doctor Speedy and ME in search of medical honesty
Weasel words on interstitial cystitis:
ReplyDeletehttp://www.bmj.com/cgi/eletters/339/jul ... 707#218935
CLINICAL REVIEW:
The management of interstitial cystitis or painful bladder syndrome in women
Marinkovic et al. (31 July 2009)
The management of interstitial cystitis or painful bladder syndrome in women
An elephant in the room - psychological factors in painful bladder syndrome
20 August 2009
Timothy R Nicholson,
Honorary SpR in Psychiatry
Department of Psychological Medicine, Institute of Psychiatry, London SE5 8=
AF,
Richard A. Kanaan, Simon Wessely
Dr Marinkovic's article(1) highlights painful bladder syndrome as a
common and debilitating set of urological symptoms which lacks
explanatory cystoscopic abnormalities. The authors highlight the
association of this condition with sexual abuse and although the study
they reference is a postal survey with poor response rate(2) other
studies have found similar associations(3). The article also details
associations with fibromyalgia, chronic fatigue syndrome and,
strikingly, a 100-fold increased risk of irritable bowel syndrome -
all of which have good evidence for the role, at least in part, of
psychological factors in their aetiology or maintenance. There is also
evidence for very high rates of psychological disorder in interstitial
cystitis / painful bladder syndrome with 14% having panic disorder(4)
and 69% having depression(3).
What are we to make of these associations? The interaction between
physical symptoms, such as those of painful bladder syndrome, and
psychological factors is likely to be bi-directional, and it is
possible that psychiatric disorders such as depression are just
sequelae of a disorder that greatly affects quality of life. It is
also plausible that psychological and physical disorders are both the
end product of the same biological process, as may be the case with
irritable bowel syndrome, and there is some evidence for this with
panic disorder being proposed as part of a genetic syndrome when
occurring with interstitial cystitis(5). However, it is also highly
possible that psychological factors have an aetiological contribution
to conditions such as painful bladder syndrome. Such disorders, where
physical pathology cannot fully account for symptoms, are known as
=93medically unexplained=94 or =93functional=94 (somatic) syndromes. These
syndromes are common to all specialities of medicine and it has been
proposed they may be the same underlying disorder manifesting itself
in different bodily systems(6).
Dr Marinkovic, however, despite drawing out the evidence for such a
description, seems to resist the inference, making no mention of
psychological factors even as possible contributors to the aetiology
or treatment of painful bladder syndrome. There may be concern that
considering a syndrome to be a functional somatic syndrome is a
counsel of despair and represents giving up on serious therapeutic
research. The experience of other functional somatic syndromes, by
contrast, is that a biopsychosocial approach is the foundation of
successful cognitive- behavioural therapy(7,8). This has been proposed
by others(3,4) and surely deserves a place in any review painful
bladder syndrome, even if only in the =91future treatments=92 section.