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Evaluation of Central Sensitisation in Bladder Pain Syndrome: A Systematic Review

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Abstract

Introduction and Hypothesis

Bladder pain syndrome (BPS) is a debilitating condition characterised by exaggerated bladder sensations and altered bladder function. It is still unknown whether the condition is a peripheral sensory problem or due to abnormal central sensory processing as seen in central sensitisation. This systematic review, which followed a published and Prospective Register of Systematic Reviews-registered protocol (CRD42021229962), is aimed at establishing the scope of central sensitisation in patients with BPS to aid optimal management and treatment.

Methods

Four databases were searched, and appraisal of the identified studies was conducted by two independent reviewers based on eligibility criteria: patients with BPS being investigated for central sensitisation with or without comparison of controls, English-language articles, full text and publication in a peer-reviewed journal. The Methodological Index for non-Randomised Studies was used to determine study quality. We identified 763 papers in total, with 15 studies included in the final analysis. All studies were observational and had a low risk of bias. Measures included in the evaluation of CS were questionnaires, urodynamics, and quantitative sensory testing methods.

Results

There was evidence of central sensitisation in patients with BPS in all papers evaluated (15 out of 15). In addition, more significant central sensitisation correlated with severe disease presentation (3 out of 3 papers) and concomitant chronic pain conditions (5 out of 5 papers).

Conclusions

Central sensitisation plays an integral role in BPS patient pathology. Many secondary measures are used to evaluate this condition. Stratification of patients based on their pathology (peripheral, central or a combination of the two) will aid in implementing an individualised management strategy.

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Data Availability

The data that support the findings of this paper are available on request from the lead author.

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Acknowledgements

The authors would like to thank Thomas Arnold for his help in the original literature search.

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Royal Cornwall Hospital, Truro, Cornwall, TR1 3LJ, UK

    S. Knox

  2. North Bristol NHS Trust, Bristol, UK

    I. Offiah

  3. Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK

    H. Hashim

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  2. I. Offiah
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  3. H. Hashim
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Contributions

S.K.: lead author, data collection and analysis, manuscript writing; I.O.: second author, data collection and analysis, manuscript writing; H.H.: reviewer, manuscript editing.

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Correspondence to S. Knox.

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Knox, S., Offiah, I. & Hashim, H. Evaluation of Central Sensitisation in Bladder Pain Syndrome: A Systematic Review. Int Urogynecol J (2024). https://doi.org/10.1007/s00192-024-05793-5

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