Interstitial Cystitis, Levator Spasm, Bladder Pain Syndrome
Conditions
Brief summary
The goal of this clinical trial is to compare two different treatment patterns in patients with chronic bladder pain. The main questions the investigators are seeking to answer is if bladder pain improves before and after treatment using a painful bladder scale. The participant will have 5 visits to evaluate your symptoms with questionnaires, at least one procedural visit, and must participate in physical therapy and some kind of behavioral health therapy. This study will assess participant response to a bundled-care approach to chronic bladder pain both pre-and post intervention as well as compared to a group of participants receiving typical care.
Detailed description
Objectives: The goals of this research program are to evaluate the patient-reported outcomes of a multimodal care bundle for patients presenting to a multidisciplinary chronic pelvic pain clinic compared to "usual care" in an Urogynecology clinic. Primary Aim: To compare pre and post intervention self-evaluation of pain and function scores in women with chronic pain syndromes with a primary finding of urinary/bladder pain symptoms with or without levator spasm who undergo multi-disciplinary, bundled care compared with usual care in a Urogynecology clinic setting. Secondary Aims: a) To identify and phenotype "non-responders" to a bundled approach to Interstitial Cystitis/Painful Bladder Syndrome/Chronic Pelvic Pain (IC/PBS/CPP). Hypothesis: We hypothesize that a bundled, multidisciplinary care approach will significantly improve patient scores on validated outcomes questionnaires compared to usual care. Methods: All treatment plans, medications, and procedures recommended for patients involved in this study are within the current standards of care for IC/PBS/CPP, regardless of treatment arm and are known to be safe interventions. Study Design: Single center, randomized pre-post intervention/prospective cohort study32 of usual FPMRS care vs. multimodal, multidisciplinary care bundle (MMCB). Setting: Patients will be recruited from an outpatient Urogynecology clinic. They will subsequently be randomized to a Multidisciplinary chronic pelvic pain clinic at an alternate site vs. continuing usual outpatient care in Urogynecology as above.
Interventions
multimodal pain therapy
Evaluate bladder and treat Hunner lesions with kenalog or fulguration as appropriate
Patient to see behavioral health/psychiatric care
Patient to have evaluation and treatment by a trained pelvic floor physical therapist
Usual care from practicing academic Urogynecologist
Intravesical lidocaine, heparin, sodium bicarb, Kenalog, gentamicin
Topical vaginal estradiol application
UTI prevention/bladder therapeutic
Part of multimodal pain therapy
Sponsors
Study design
Intervention model description
Single center, randomized pre-post intervention/prospective cohort study of usual Urogynecology care vs. multimodal, multidisciplinary care bundle (MMCB).
Eligibility
Inclusion criteria
* Inclusion Criteria: * Female patient 18 years of age or older * diagnosis of Interstitial Cystitis/Painful Bladder Syndrome, scoring 6 points or higher on O'Leary Sant Questionnaire *
Exclusion criteria
Active pelvic or bladder infection within past 2 weeks * contraindications to medications or intervention therapeutics * inability to speak or read English * pelvic floor interventional procedure including bladder instillations 4 weeks prior to study recruitment * meets criteria for diagnostic laparoscopy * internal referral (to reduce severity bias) Note: patients are not excluded for currently taking any medication on the treatment list. Patients can be treated for UTI during the study period.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| --O'Leary Sant Questionnaire (OLS), Comprised of Interstitial Cystitis Symptom Index (ICSI) and Problem Index (ICPI), Change at 12 Weeks From Baseline | Baseline, 12 weeks | This survey assesses IC/BPS symptoms and a change in \> or equal to 4 points is considered clinically significant. A higher score change indicates less pain and urinary symptoms. The minimum possible score is 0. The maximum possible score is 37. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Healthcare Encounters Motivated on Pain | Baseline to 12-month | Number of encounters with the UPMC healthcare system that include emergency room visits, provider calls, provider visits, procedures, and other treatments based on documentation within their medical record. |
Countries
United States
Contacts
University of Pittsburgh
Participant flow
Recruitment details
Chronic Pelvic Pain Study, UPMC Magee's Women's Hospital, Recruited from 12/6/2022 to 9/25/2024
Baseline characteristics
| Characteristic | — |
|---|---|
| Age, Customized Age Demographics Ages 18-29 years | 11 Participants |
| Age, Customized Age Demographics Ages 30-42 years | 8 Participants |
| Age, Customized Age Demographics Ages 43-55 years | 5 Participants |
| Age, Customized Age Demographics Ages 56-68 years | 2 Participants |
| Age, Customized Age Demographics Ages 69+ years | 0 Participants |
| Body Mass Index (BMI) Healthy weight: BMI 18.5-24.9 | 10 Participants |
| Body Mass Index (BMI) Obese: BMI >30 | 8 Participants |
| Body Mass Index (BMI) Overweight: BMI 25-29.9 | 6 Participants |
| Body Mass Index (BMI) Underweight: BMI < 18.5 | 0 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 26 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Menopausal Status Postmenopausal, HRT | 2 Participants |
| Menopausal Status Postmenopausal, no HRT | 2 Participants |
| Menopausal Status Premenopausal | 8 Participants |
| Menopausal Status Uncertain | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) White | 25 Participants |
| Sex: Female, Male Female | 26 Participants |
| Sex: Female, Male Male | 0 Participants |
| Smoking Status Current Smoker | 0 Participants |
| Smoking Status Former Smoker | 2 Participants |
| Smoking Status Never Smoked | 24 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 16 | 0 / 10 |
| other Total, other adverse events | 0 / 16 | 0 / 10 |
| serious Total, serious adverse events | 0 / 16 | 0 / 10 |