Clinical Conditions.
Journal: J Urol. 2009 Sep 14. [Epub ahead of print]
Authors: Rodr=EDguez MA, Afari N, Buchwald DS; National Institute of=20
Diabetes and Digestive and Kidney Diseases Working Group on=20
Urological Chronic Pelvic Pain.
Affiliation: Department of Psychology, University Rey Juan Carlos,=20
Madrid, Spain.
PMID: 19758633
PURPOSE: Unexplained clinical conditions share common features such=20
as pain, fatigue, disability out of proportion to physical=20
examination findings, inconsistent laboratory abnormalities, and an=20
association with stress and psychosocial factors. We examined the=20
extent of the overlap among urological and nonurological unexplained=20
clinical conditions characterized by pain. We describe the=20
limitations of previous research and suggest several possible=20
explanatory models.
MATERIALS AND METHODS: Using hallmark symptoms and syndromes as=20
search terms a search of 12 databases identified a total of 1,037=20
full-length published articles in 8 languages from 1966 to April=20
2008. The search focused on the overlap of chronic pelvic pain,=20
interstitial cystitis, painful bladder syndrome, chronic=20
prostatitis/chronic pelvic pain syndrome or vulvodynia with=20
fibromyalgia, chronic fatigue syndrome, temporomandibular joint and=20
muscle disorders or irritable bowel syndrome. We abstracted=20
information on authorship, type of case and control groups,=20
eligibility criteria, case definitions, study methods and major findings.
RESULTS: The literature suggests considerable comorbidity between=20
urological and nonurological unexplained clinical conditions. The=20
most robust evidence for overlap was for irritable bowel syndrome and=20
urological unexplained syndromes with some estimates of up to 79%=20
comorbidity between chronic pelvic pain and symptoms of irritable=20
bowel syndrome. However, most studies were limited by methodological=20
problems, such as varying case definitions and selection of controls.
CONCLUSIONS: The overlap between urological and selected=20
nonurological unexplained clinical conditions is substantial. Future=20
research should focus on using standardized definitions, and=20
rigorously designed, well controlled studies to further assess=20
comorbidity, clarify the magnitude of the association and examine=20
common pathophysiological mechanisms.
=20
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