Do medication prescription patterns follow guidelines in a cohort of women with interstitial cystitis/bladder pain syndrome?

Abstract

To describe prescription prevalence of oral bladder pain medications among women with interstitial cystitis/bladder pain syndrome (IC/BPS) and to compare with current treatment guidelines. Methods: We sampled female patients with an ICD-9/10 diagnosis of IC/BPS (595.1/N30.10) by querying active users of the Veterans Health Administration. Medical records were reviewed to determine whether patients met IC/BPS diagnostic criteria. A cohort of women with other pelvic pain disorders was identified. Prescription prevalence of typical non-narcotic oral bladder pain medications was compared between the two groups and healthy controls.Prescription prevalence was also compared before and after the diagnosis of IC/BPS was made using Poisson regression.Results: There were 641 women who met criteria for IC/BPS and 197 women with "Other pelvic pain" disorders. Women with IC/BPS were prescribed a pain medication more often than those with "Other pelvic pain" (77% vs. 59%, p < 0.0001). Of the women with IC/BPS, 44% tried three or more pain medications. Of women with a diagnosis of IC/BPS, only 67% were prescribed an American Urological Association-recommended medication. Prescription prevalence increased after diagnosis for both pentosan polysulfate (10%-29%, p < 0.0001) and hydroxyzine (17%-40%, p < 0.0001), but not for amitriptyline or cimetidine. Amitriptyline was prescribed to 223 women with IC/BPS, only 125 of which (56%) had a documented history of depression.Conclusions: Many women with IC/BPS required multiple bladder prescriptions, highlighting the difficulty in finding an effective treatment for IC/BPS. Pentosan polysulfate and hydroxyzine were preferred IC/BPS medications.Our next step will be to analyze treatment patterns in those patients who did not receive medications.

Quality-of-life impact of interstitial cystitis and other pelvic pain syndromes

“…This analysis found that IC/BPS patients were given nonnarcotic bladder pain medication more often than those with OPPCs. Despite this fact and observing that over 77% of women with IC/BPS in the study received treatment, we found that IC/BPS patients had a significant increase in the number of medications used and required multiple prescriptions for pain, highlighting the difficulty in effectively treating IC/BPS ( 20 ). These treatment findings help support the conclusion that IC/BPS have worse urologic pain compared to OPPCs as demonstrated on the GUPI.…”

“…The improvements in GUPI components in both cohorts may in part reflect these treatments. We previously conducted a retrospective analysis of women with confirmed IC/BPS and those with OPPC using the same cohort definitions to identify prescription rates of nonnarcotic pain medications used in treating these conditions ( 20 ). This analysis found that IC/BPS patients were given nonnarcotic bladder pain medication more often than those with OPPCs.…”