Urologic And Non-Urologic Unexplained Clinical Conditions Overlap

Main Category: Urology / Nephrology
Also Included In: Fibromyalgia;  Irritable-Bowel Syndrome;  Pain / Anesthetics
Article Date: 30 Nov 2009 - 6:00 PDT

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UroToday.com - Unexplained clinical conditions have been referred to by many names including functional somatic syndromes. They are characterized by a lack of clear physical or biological etiology, or inconsistent demonstration of laboratory abnormalities. Bladder pain syndrome and chronic pelvic pain syndrome (CPPS) in men NIDDK type 3 (nonbacterial prostatitis) would fall under this umbrella. Rodriguez and co-workers from Madrid, San Diego, and Seattle reviewed the literature on comorbidity between the most common urological pelvic pain syndromes (BPS, CPPS), vulvodynia, and the nonurological conditions of fibromyalgia, chronic fatigue syndrome, temporomandibular joint and muscle disorders, and irritable bowel syndrome.

These conditions are characterized by symptoms such as pain, fatigue, sleep disturbances, and disability. The authors point out that the diagnosis often depends on the hallmark symptom and the expertise of the treating clinician rather than on the illness itself. They found 25 publications on comparison studies that provided data on the comorbidity of urological and nonurological unexplained clinical conditions or symptoms, 68% of which were published in the last 4 years!

About 9% to 12% of patients with BPS also experienced fibromyalgia and 23-27% of patients with fibromyalgia also had symptoms consistent with BPS. Seven percent to 48% of patients with BPS or symptoms of BPS also had irritable bowel syndrome. Twenty-two percent of men with CPPS or its symptoms had irritable bowel syndrome. Thirty to 75% of individuals with BPS or BPS symptoms had irritable bowel syndrome in single condition studies, and 25%-56% of patients with irritable bowel syndrome had urinary problems. Likewise, 19%-79% of patients with CPPS had IBS or IBS symptoms. Of women with vulvar pain, 35% reported IBS. Studies of fibromyalgia, chronic fatigue syndrome, and temporomandibular joint pain suggest more modes comorbidity with urological syndromes.

The authors identified 3 dominant perspectives on the mechanisms of these conditions:

1) physiological processes, particularly neuroendocrine, immunological and neurotransmitter dysfunctions in the central nervous system,
2) victimization, abuse and trauma, and
3) psychological distress, psychiatric disorders, stress tolerance and recovery from stress.

This article is an excellent resource for providers interested in the gamut of chronic unexplained pain conditions.

Rodríguez MA, Afari N, Buchwald DS
J Urol. 2009 Nov;182(5):2123-31
doi:10.1016/j.juro.2009.07.036

Written by UroToday.com
Contributing Editor Philip M. Hanno, MD, MPH

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