title: Before the onset of interstitial cystitis/bladder pain syndrome, the presence of multiple non-bladder syndromes is strongly associated with a history of multiple surgeries.
abstract: OBJECTIVE
  Certain functional somatic syndromes (FSSs) such as fibromyalgia and irritable bowel syndrome are accompanied by diffuse pain amplification. Women with interstitial cystitis/bladder pain syndrome (IC/BPS) have numerous FSSs, as well as other non-bladder syndromes (NBSs) that are linked to the FSSs. They also report multiple surgeries. Since pain is a common indication for surgery, we tested the hypothesis that NBSs were associated with surgeries.
  
  
  METHODS
  We interviewed 312 incident IC/BPS cases and controls on NBSs and number of surgeries before the index date (for cases, IC/BPS onset date). Poisson and logistic regression analyses adjusted for age, race, educational level, and menopause.
  
  
  RESULTS
  Number of surgeries increased with number of NBSs in both cases and controls whether chronic pelvic pain (CPP), the only NBS generally accepted as an indication for surgery, was present or not. Logistic regression analysis showed that among cases CPP was the only individual NBS associated with a history of multiple surgeries, and then only modestly [odds ratio (OR) 1.9, confidence intervals (CI) 1.06, 3.2]. By far the strongest association was the number of NBSs. The OR for multiple surgeries increased with number of NBSs: for cases with 4-5 NBSs the OR was 14.1 (1.8, 113) and with 6-9 NBSs, 33.1 (3.9, 279). Controls had fewer syndromes and fewer surgeries and this linkage was less prominent.
  
  
  CONCLUSIONS
  Among IC/BPS cases, the number of NBSs was strongly correlated with the number of surgeries. Understanding temporal relationships will be necessary to explore causal linkages and may modify surgical practice.
authors.affiliation: Department of Medicine, University of Maryland School of Medicine, United States; Department of Epidemiology and Public Health, University of Maryland School of Medicine, United States. Electronic address: jwarren@medicine.umaryland.edu.
authors.forename: John W
authors.initials: JW
authors.lastname: Warren
authors.affiliation: Department of Obstetrics and Gynecology, University of Maryland School of Medicine, United States.
authors.forename: Vadim
authors.initials: V
authors.lastname: Morozov
authors.affiliation: Department of Obstetrics and Gynecology, University of Rochester School of Medicine, United States.
authors.forename: Fred M
authors.initials: FM
authors.lastname: Howard
authors.affiliation: Departments of Anesthesiology and Neurology, University of Alabama School of Medicine, United States.
authors.forename: Ursula
authors.initials: U
authors.lastname: Wesselmann
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine, United States; The Prevention and Research Center, Mercy Medical Center, Baltimore, MD, United States.
authors.forename: Lisa
authors.initials: L
authors.lastname: Gallicchio
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine, United States.
authors.forename: Patricia
authors.initials: P
authors.lastname: Langenberg
authors.affiliation: Departments of Anesthesiology and Medicine, University of Michigan School of Medicine, United States.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Clauw
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D059350:Chronic Pain / Q000209:etiology*; D018856:Cystitis, Interstitial / Q000209:etiology*; D005260:Female; D005356:Fibromyalgia / Q000150:complications; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000150:complications; D016015:Logistic Models; D008875:Middle Aged; D016017:Odds Ratio; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000706:statistics & numerical data*; D001743:Urinary Bladder / Q000503:physiopathology*
keywords: Bladder pain; Functional somatic syndromes; Interstitial cystitis; Surgeries