Laura Katz

A feasibility trial of a cognitive-behavioural symptom management program for chronic pelvic pain for men with refractory chronic prostatitis/chronic pelvic pain syndrome

BACKGROUND Our objective was to determine the feasibility of a cognitive behavioural symptom management program for the acute improvement of psychosocial risk factors of diminished quality of life (QoL) in men suffering from chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). MATERIALS AND METHODS We assessed CP/CPPS symptoms and impact (i.e., chronic prostatitis symptom index [CPSI] pain, urinary, QoL domains), psychosocial risk factors were assessed at baseline and weekly for 8 weeks. We included the following psychosocial risk factors: catastrophizing (Pain Catastrophizing Scale, PCS), mood (Center for Epidemiological Studies in Depression Scale, CES-D), social support (Multidimensional Scale of Perceived Social Support, MSPSS) and general pain (McGill Pain Questionnaire). Patient sessions dispute and replace pessimistic thinking with health-focused thinking and behaviour. RESULTS Eleven men completed the psychosocial management program (mean age = 51.3, standard deviaton [SD] = 12.49). Mean CPSI baseline total score was 25.2 (SD = 10.21). Repeated measures ANOVAs showed the program was associated with significant linear reductions for pain (p = 0.051), disability (p= 0.020) and catastrophizing (p = 0.005), but no changes in depressive symptoms or social support. The CPSI baseline scores compared to follow-up scores (n = 8) were significantly reduced (p = 0.007), with CPSI pain (p = 0.015) and QoL impact (p = 0.013) reduced, but not for urinary scores. Correlations between change scores at the baseline and at 8 weeks for CPSI and psychosocial risk factors indicated that reductions in catastrophizing were most strongly associated with score reductions for the CPSI; these reductions, however, were not significant. CONCLUSIONS The psychosocial management program targets and significantly reduces several empirically supported psychosocial risk factors associated with poorer CP/CPPS outcomes. Psychosocial management for CP/CPPS is feasible, but requires a randomized controlled trial with longitudinal follow-up.

Disability in women suffering from interstitial cystitis/bladder pain syndrome

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a disease that is associated with significant disability in the areas of self‐care, sexual functioning, occupation, family and home responsibilities, and social functions. Compared to age‐ and cohort‐matched controls, patients with IC/BPS reported poorer mental and physical quality of life (QoL), as well as greater pain, depression, anxiety, catastrophizing, sexual dysfunction and less social support. In particular, catastrophizing and depression are suggested to be important for understanding the factors promoting a poorer QoL in IC/BPS. The findings of the present study suggest that psychosocial factors are significant in mediating the relationship between impairments and patient disability, with negative affect (i.e. depression, anxiety) and pain catastrophizing acting as significant mediators. These findings argue that catastrophizing and negative affect may be the mechanisms by which pain and symptoms elevate reports of patient disability. Understanding how pain and pain‐associated symptoms may become disabling through cognitive mechanisms represents an importance advance for IC/BPS management. Clinical interventions in women suffering from IC/BPS should target catastrophizing and mood for reduction using cognitive behavioural strategies aiming to decrease pain‐related disability.

Impact of depression and anxiety on the quality of life of constipated patients.

Constipation negatively affects quality of life (QOL), however, the specific mechanisms through which this relationship occurs are unclear. The present study examined anxiety and depression as potential mediators of the relationship between constipation severity and QOL in a sample of 142 constipated patients. Results indicated that depression symptom severity mediated the relationship between constipation severity and mental health-related QOL. For patients meeting diagnostic criteria for Major Depressive Disorder, indirect effects were observed in the relationship between constipation severity and both physical and mental health-related QOL. Anxiety did not contribute to this model. Treating depression may be useful in improving QOL in severely constipated patients, which highlights the importance of psychological screening and treatment referrals in primary care settings.

Understanding pain and coping in women with interstitial cystitis/bladder pain syndrome

To examine a self‐regulation and coping model for interstitial cystitis/bladder pain syndrome (IC/BPS) that may help us understand the pain experience of patients with chronic IC/BPS.