Acupuncture for female bladder pain syndrome: a randomized controlled trial.

INTRODUCTION: Growing evidence supports acupuncture for several pain conditions including chronic prostatitis. This study aimed to determine the safety, tolerability, and effectiveness of acupuncture in reducing pain in women with interstitial cystitis/bladder pain syndrome (IC/BPS). MATERIALS AND METHODS: This prospective randomized single-blinded study compared electro-acupuncture (EA) to minimal acupuncture (MA) after 6 weekly treatments and again after 6 weeks of no treatment. Pain was assessed using the Brief Pain Inventory-Short Form (worst pain, average pain, pain severity, pain interference) and the Pain Catastrophizing Scale (PCS). Physical exams evaluated pelvic floor muscle tenderness. Mixed-effects models were used to estimate adjusted means over follow up. RESULTS: Patients were randomized to EA (n = 11) or MA (n = 10). There were no adverse events. Both groups' worst pain improved at 6 weeks, -2.91 ± 0.59 and -2.09 ± 0.68 for EA and MA respectively with no difference between groups (p = 0.37). Results were similar at 12 weeks. The EA group had greater improvement in pain interference at 6 weeks, -3.28 ± 0.51 versus -1.67 ± 0.58 (p = 0.049). The between group difference was not maintained at 12 weeks (p = 0.13). Average pain and pain severity showed no difference between groups (p > 0.05). The PCS improved overall at 6 weeks, -6.2 ± 2.5 (p = 0.03), with no difference between groups (p = 0.39). On physical exam, only the EA group showed a significant decrease in levator ani tenderness (p = 0.031) after treatment. CONCLUSIONS: Both EA and MA showed improvement in worst pain scores, however EA showed greater improvement in pain interference and pelvic floor muscle tenderness in women with IC/BPS.

How Involved Do Patients Want to Be in the Medical Decision-Making at the Initial Urogynecology Clinic Visit?

OBJECTIVE: The aim of this study was to compare patients' preferred role in medical decision-making before the initial urogynecology visit to their perceived role after the visit. METHODS: This prospective cohort study enrolled women presenting for their initial urogynecology visit. Before and after the visit, patients completed the Control Preference Scale (CPS), which categorizes the role that patients want to have in medical decision-making: active, collaborative, or passive. Patients also completed the Pelvic Floor Distress Inventory, CollaboRATE, Patient Global Impression of Improvement, patient satisfaction, and Short Test of Functional Health Literacy in Adults questionnaires. Univariable and multivariable generalized estimating equations were used. RESULTS: Women (n = 100) with a mean age of 59.1 years (SD = 15.5) participated in the study. Based on CPS before the visit, 50% of the women preferred active involvement, whereas 45% preferred collaborative and 5% preferred passive involvement. After the visit, these rates change to 40%, 48%, and 11%, respectively. On univariable analysis, women were 1.56 times more likely to report a collaborative or passive CPS response after the visit (P = 0.02). This remained true on multivariable analysis (odds ratio, 1.57; P = 0.04). Patients' CPS responses were not associated with their responses on CollaboRATE, Patient Global Impression of Improvement, patient satisfaction, or Short Test of Functional Health Literacy in Adults. Eighty-eight percent of women reported a fully collaborative visit based on CollaboRATE, and 87% reported being "completely satisfied" with the visit. CONCLUSIONS: Despite a change in women's reported involvement in decision-making after their first urogynecology visit compared with their preferences before the visit, most women perceived collaboration during their visit and were completely satisfied.

Clinical Outcomes of a Multidisciplinary Female Chronic Pelvic Pain Program.

OBJECTIVE: The aim of this study was to describe patient-reported longitudinal outcomes in a multidisciplinary female chronic pelvic pain (CPP) program. METHODS: We conducted a retrospective cohort study for women cared for in a tertiary, multidisciplinary, female (CPP) program between 2012 and 2017. Patient demographics were collected from electronic medical records. Patients completed the numerical rating scale for pain, Pain Disability Index (PDI), and Patient Global Impression of Improvement scale at each visit. Mixed-effects models were used to assess change in patient responses over time. RESULTS: Patients (N = 317) with a mean age of 44.3 years (SD, 14.6) and median duration of symptoms of 3 years (interquartile range, 1.0-7.0) were assessed in this analysis. The primary diagnosis was pelvic floor myofascial pain (67%). On multivariable analysis, numerical rating scale scores decreased by -0.11 point [95% confidence interval (CI), -0.20 to -0.01] every 3 months (P = 0.03). On multivariable analysis, total PDI score decreased by -0.88 point (95% CI, -1.43 to -0.33) (P = 0.003), and PDI sexual subscores decreased by -0.29 point (95% CI, -0.44 to -0.14) (P < 0.001) every 3 months. A higher (worse) Patient Global Impression of Improvement score was associated with a higher (worse) PDI score at follow-up (odds ratio, 1.04; 95% CI, 1.01-1.07; P = 0.01). CONCLUSIONS: Patients in a multidisciplinary CPP program demonstrated improvement over time in pain disability that was associated with an overall global impression of improvement.

Evaluating Disability-Related Quality of Life in Women With Chronic Pelvic Pain.

OBJECTIVES: The primary aim of this study was to describe quality of life (QOL) in women with chronic pelvic pain using the Pain Disability Index (PDI). A secondary goal was to assess the measurement properties and validity of the PDI for this population. METHODS: This study was a cross-sectional retrospective chart review. In the setting of an outpatient female pelvic pain clinic, we included data from an initial evaluation of patients 16 years and older with chronic pelvic pain (N = 317) from 2012 to 2017. Quality of life was measured using the PDI and previously validated measures for depression and anxiety. RESULTS: The mean PDI score across all patients was similar to previously reported means for similar chronic pain populations. Patients experienced the most disability in their sexual activities. The most common cause of chronic pelvic pain was pelvic floor myofascial pain. Common diagnostic categories covered gynecologic, urologic, gastrointestinal, musculoskeletal, and neurological causes. The PDI was unable to discriminate between diagnoses. On average, patients qualified for mild depression and anxiety diagnoses. Results from a confirmatory factor analysis revealed the original factor structure for the PDI fits this population. CONCLUSIONS: The PDI shows promise as a questionnaire for QOL and could be a valuable clinician tool for tracking QOL in the chronic pelvic pain population. Additional research should be focused on assessing its ability to measure minimum clinically significant change over time.

Mental Health-Related Healthcare Use Following Bilateral Deep Brain Stimulation For Parkinson's Disease.

BACKGROUND: The subthalamic nucleus (STN) and the globus pallidus internus (GPi) are both effective targets for deep brain stimulation (DBS) to relieve motor symptoms of Parkinson's disease. However, studies have reported varied effects on mental health-related adverse events and depressed mood following DBS. OBJECTIVE: The current observational study sought to compare mental health healthcare utilization and costs for three years following STN or GPi DBS. METHODS: For a cohort of Veterans (n = 161) with Parkinson's disease who participated in a larger multi-site randomized trial, we compared mental health outpatient visits, medication use, inpatient admissions, and associated costs by DBS target site (STN vs. GPi). RESULTS: Neither group nor time differences were significant for mental health outpatient or inpatient utilization following DBS. Overall costs associated with mental health visits and medications did not differ by time or by group. However, the percentage of patients with mental health medication use increased in the 6-month and 6 to 12 month periods post-surgery. The STN group had significantly greater increase in medication use at 6 to 12 months post-surgery compared to the GPi group (p <  0.05). CONCLUSION: Despite a brief increase in medication use following surgery, this study suggests that mental health healthcare use and costs are stable over time and similar between DBS targets. Prior research findings of mental health-related adverse events and mood following DBS did not translate to greater mental health service utilization in our cohort. The changes seen in the year following surgery may reflect temporary adjustments with stabilization over time.

Dopamine transporter genotype predicts implicit sequence learning.

Implicit learning, the non-conscious acquisition of sequential and spatial environmental regularities, underlies skills such as language, social intuition, or detecting a target in a complex scene. We examined relationships between a variation of the dopamine transporter (DAT1) gene (SLC6A3), which influences dopamine transporter expression in the striatum, and two forms of implicit learning that differ in the regularity to be learned and in striatal involvement. Participants, grouped as 9-repeat carriers or 10/10 homozygotes, completed the triplets learning task (TLT) and the spatial contextual cueing task (SCCT). The TLT assesses sequence learning, recruiting the striatal system, particularly as training continues. In contrast, the SCCT assesses spatial context learning, recruiting medial temporal brain networks. For both tasks, participants demonstrated learning in faster and/or more accurate responses to repeating patterns or spatial arrays. As predicted, TLT learning was greater for the 9-repeat carriers than the 10/10 group (despite equal overall accuracy and response speed) whereas there were no significant group differences in SCCT. Thus, presence of the DAT1 9-repeat allele was beneficial only for implicit sequence learning, indicating the influence of DAT1 genotype on one form of implicit learning and supporting evidence that implicit learning of sequential dependencies and spatial layouts recruit different neural systems.