Structural Autonomic Evaluation in Chronic Pelvic Pain Syndromes

      Background: Functional abnormalities of the autonomic nervous system (ANS) often occur in chronic pain, including chronic pelvic pain (CPP). Hypothesis: abnormal ANS innervation of the bladder underlies bladder pain syndrome (BPS). We therefore compared ANS testing in pa-tients with 2 types of CPP: BPS and myofascial pelvic pain (MPP), and healthy control subjects (HC). Methods: In this IRB approved protocol, with 39 HC, 36 BPS, 14 MPP and 41 BPS + MPP sub-jects underwent one cardiac parasympathetic test, [deep breathing (DB)], two cardiac and vas-cular autonomic tests [valsalva maneuver and tilt table test (HUT)], and post-ganglionic sudo-motor sympathetic test that evaluated for autonomic neuropathy (AN). A validated composite autonomic laboratory score was applied. Results: Cardiac response to DB did not differ among groups. HUT was more frequently abnormal in CPP than HC, (36/91, 40% vs 4/39, 10%, p < 0.001), most frequent diagnosis was orthostatic intolerance. Physiologic HUT diagnoses such as orthostatic hypotension, postural tachycardia syndrome and syncope occurred rarely. AN was more frequent in CPP (28/91, 31% vs 5/39, 10% p = 0.01). CPP groups did not differ from one another in either of these abnormalities. Discussion: Our preliminary study on 14 BPS subjects and 15 HC found no structural autonomic abnormality in CPP. This final report based on 130 subjects confirms absence of autonomic cardiovascular abnormalities. Symptoms in the upright position (orthostatic intolerance) on tilt may suggest central sensitization. The increased frequency of AN in almost a third of subjects with CPP needs further investigation. Funding Source: ICEPAC project funded by NIH-NIDDK R01DK083538.
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