Noninvasive bladder testing of adolescent females to assess visceral hypersensitivity

Abstract

Excess pain after visceral provocation has been suggested as a marker for chronic pelvic pain risk in women. However, few noninvasive tests have been validated that could be performed readily on youth in early risk windows. Therefore, we evaluated the validity and reliability of a noninvasive bladder pain test in 124 healthy premenarchal females (median age 11, [interquartile range 11-12]), as previously studied in adult women. We explored whether psychosocial, sensory factors, and quantitative sensory test results were associated with provoked bladder pain and assessed the relation of bladder pain with abdominal pain history. Compared with findings in young adult females (age 21 [20-28]), results were similar except that adolescents had more pain at first sensation to void (P 5 0.005) and lower maximum tolerance volume (P , 0.001). Anxiety, depression, somatic symptoms, and pain catastrophizing predicted provoked bladder pain (P's , 0.05). Bladder pain inversely correlated with pressure pain thresholds (r 5 20.25, P , 0.05), but not with cold pressor pain or conditioned pain modulation effectiveness. Bladder pain was also associated with frequency of abdominal pain symptoms (r 5 0.25, P 5 0.039). We found strong retest reliability for bladder pain at standard levels of sensory urgency in 21 adolescents who attended repeat visits at 6 to 12 months (intraclass correlations 5 0.88-0.90). Noninvasive bladder pain testing seems reproducible in adolescent females and may predict abdominal pain symptomatology. Confirmation of our findings and further investigation of the bladder test across menarche will help establish how visceral sensitivity contributes to the early trajectory of pelvic pain risk.

Neurobiology and long-term impact of bladder-filling pain in humans: a Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) research network study

“…Naturalistic paradigms that evoke visceral hypersensitivity are advantageous because patients consider the symptoms central to their functional limitations. 34,35 In addition to identifying patients with bladder-filling pain, the test also identified a group of participants meeting criteria for UCPPS that have almost no response to bladder filling-similar to healthy controls. This suggests intact neurobiological mechanisms for gauging bladder sensations, discussed further below.…”

Amygdalar functional connectivity during resting and evoked pain in youth with functional abdominal pain disorders

“…As designed (eg, due to the length of time of the research activities and supine lying position of the participants), the task reliably induced visceral upper GI fullness as opposed to bladder fullness or an urge to void. 66…”

“…As designed (eg, due to the length of time of the research activities and supine lying position of the participants), the task reliably induced visceral upper GI fullness as opposed to bladder fullness or an urge to void. 66 anchored with the words "no pain intensity/unpleasantness" and "most pain intensity/unpleasantness imaginable". 53 The further the participant moved the slider to the right indicated higher levels of pain symptoms.…”