Cognitive Behavioral Therapy for Chronic Pelvic Pain: What Is It and Does It Work?

PURPOSE: Urologic chronic pelvic pain syndrome (UCPPS), which encompasses interstitial cystitis/bladder pain syndrome in women and men and chronic prostatitis/chronic pelvic pain syndrome in men, is a common, often disabling urological disorder that is neither well understood nor satisfactorily treated with medical treatments. The past 25 years have seen the development and validation of a number of behavioral pain treatments, of which cognitive behavioral therapy (CBT) is arguably the most effective. CBT combines strategies of behavior therapy, which teaches patients more effective ways of behaving, and cognitive therapy, which focuses on correcting faulty thinking patterns. As a skills-based treatment, CBT emphasizes "unlearning" maladaptive behaviors and thoughts, and replacing them with more adaptive ones that support symptom self-management. MATERIALS AND METHODS: This review describes the rationale, technical procedures, and empirical basis of CBT. RESULTS: While evidence supports CBT for treatment-refractory chronic pain disorders, there is limited understanding of why or how CBT might work, for whom it is most beneficial, or the specific UCPPS symptoms (eg, pain, urinary symptoms) it effectively targets. This is the focus of EPPIC (Easing Pelvic Pain Interventions Clinical Research Program), a landmark NIH trial examining the efficacy of low-intensity, home-based CBT for UCPPS relative to a nonspecific comparator featuring self-care recommendations of AUA guidelines. CONCLUSIONS: Systematic efforts to increase both the efficiency of CBT and the way it is delivered (eg, home-based treatments) are critical to scaling up CBT, optimizing its therapeutic potential, and reducing the public health burden of UCPPS.

Clinical Utility of Classical and Nonclassical Monocyte Percentage in the Diagnosis of Chronic Myelomonocytic Leukemia.

OBJECTIVES: To determine if a clinically applicable flow cytometry methodology could identify chronic myelomonocytic leukemia (CMML) cases. METHODS: Monocyte subset screening (CD14/CD16 expression) was performed on 68 blood and 25 bone marrow specimens with a monocytosis and/or flagged as possible CMML. Fifty thousand total events were obtained per case. Cases were categorized as CMML, atypical chronic myeloid leukemia (aCML), or non-CMML + non-aCML by clinicopathologic diagnosis. RESULTS: The methodology differentiated blood and bone marrow CMML cases from non-CMML + non-aCML but not three aCML cases in the clinical setting. Furthermore, a decreased percentage of nonclassical monocytes (CD14dimCD16+) showed better sensitivity than the previously described approach that relied on increased percentage of classical monocytes (CD14brightCD16-). CONCLUSIONS: Quantification of monocyte subsets is useful in clinical practice as a diagnostic marker of CMML in blood and bone marrow specimens. The percentage of nonclassical monocytes should be included in analysis of monocyte subsets.