title: Functional somatic syndromes as risk factors for hysterectomy in early bladder pain syndrome/interstitial cystitis.
abstract: OBJECTIVE
  We tested the hypothesis that functional somatic syndromes (FSSs) are risk factors for hysterectomy in early bladder pain syndrome/interstitial cystitis (BPS/IC).
  
  
  METHODS
  In 312 women with incident BPS/IC, we diagnosed seven pre-BPS/IC syndromes: chronic pelvic pain (CPP), fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome (IBS), sicca syndrome, migraine, and panic disorder. Each was defined as present before 12 months (existing syndrome) or onset within 12 months (new syndrome) prior to BPS/IC onset. Retrospectively, we sought associations between prior hysterectomy and existing FSSs. Prospectively, we studied associations of existing and new syndromes with subsequent hysterectomy. Logistic regression analyses adjusted for age, race, menopause and education.
  
  
  RESULTS
  The retrospective study showed prior hysterectomy (N=63) to be associated with existing CPP and the presence of multiple existing FSSs. The prospective study revealed that 30/249 women with a uterus at baseline (12%) underwent hysterectomy in early BPS/IC. This procedure was associated with new CPP (OR 6.0; CI 2.0, 18.2), new IBS (OR 5.4; CI 1.3, 22.3), and ≥3 existing FSSs (OR 3.9; CI 1.1, 13.9).
  
  
  CONCLUSIONS
  Accounting for CPP and IBS, the presence of multiple FSSs (most without pelvic pain) was a separate, independent risk factor for hysterectomy in early BPS/IC. This suggests that patient features in addition to abdominopelvic abnormalities led to this procedure. Until other populations are assessed, a prudent approach to patients who are contemplating hysterectomy (and possibly other surgeries) for pain and who have IBS or numerous FSSs is first to try alternative therapies including treatment of the FSSs.
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 Anesthesiology, University of Michigan School of Medicine, United States; Department of Medicine, University of Michigan School of Medicine, United States.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Clauw
authors.affiliation: Department of Anesthesiology, University of Alabama at Birmingham School of Medicine, United States; Department of Neurology, University of Alabama at Birmingham School of Medicine, United States.
authors.forename: Ursula
authors.initials: U
authors.lastname: Wesselmann
authors.affiliation: Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, United States.
authors.forename: Fred M
authors.initials: FM
authors.lastname: Howard
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine, United States.
authors.forename: Lisa
authors.initials: L
authors.lastname: Gallicchio
authors.affiliation: Department of Obstetrics and Gynecology, University of Maryland School of Medicine, United States.
authors.forename: Vadim
authors.initials: V
authors.lastname: Morozov
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D059350:Chronic Pain / Q000150:complications* / Q000209:etiology / Q000523:psychology; D018856:Cystitis, Interstitial / Q000150:complications* / Q000523:psychology; D015673:Fatigue Syndrome, Chronic / Q000150:complications; D005260:Female; D005356:Fibromyalgia / Q000150:complications; D006801:Humans; D007044:Hysterectomy; D043183:Irritable Bowel Syndrome / Q000150:complications* / Q000523:psychology; D016015:Logistic Models; D008875:Middle Aged; D008881:Migraine Disorders / Q000150:complications; D016584:Panic Disorder / Q000150:complications; D017699:Pelvic Pain / Q000150:complications* / Q000209:etiology / Q000523:psychology; D011446:Prospective Studies; D011602:Psychophysiologic Disorders / Q000150:complications* / Q000523:psychology; D012189:Retrospective Studies; D012307:Risk Factors; D001743:Urinary Bladder / Q000503:physiopathology
keywords: Bladder pain syndrome; Chronic pelvic pain; Functional somatic syndromes; Hysterectomy; Interstitial cystitis; Irritable bowel syndrome