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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© 2015 Published by Elsevier Inc.