Unstimulated inflammatory activity is associated with treatment response to cognitive-behavioral therapy for urologic chronic pelvic pain

Lindsey Colman McKernan^1,2,3*Leslie J Crofford⁴Stephen Bruehl⁵Trey William McGonigle⁶Anna Grace Kelly⁷Anna M Ryden¹Susanna L Sutherland²Daniel J Clauw⁸David A Williams⁸Roger R Dmochowski³Andrew D Schrepf⁸

• ¹Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, United States
• ²Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, United States
• ³Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
• ⁴Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
• ⁵Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
• ⁶Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
• ⁷Department of Psychology, College of Humanities and Social Sciences, George Mason University, Fairfax, Virginia, United States
• ⁸Department of Anesthesiology, School of Medicine, University of Michigan, Ann Arbor, Michigan, United States

Introduction: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating urologic chronic pelvic pain condition characterized by pelvic pain and urinary symptoms. Evidence suggests that in chronic pain conditions such as IC/BPS, inflammatory markers are associated with heightened symptom severity and widespread pain. Non-pharmacological treatments such as cognitive-behavioral therapy are recommended as a core component of IC/BPS treatment.There is limited and mixed evidence as to whether inflammatory markers are affected by nonpharmacological treatments or their relationship to treatment response. This exploratory study considered how inflammatory characteristics may both predict and explain treatment response in a sample of females with interstitial cystitis. Method: Participants were randomized to receive either 8-weeks of telemedicine-delivered cognitive-behavioral therapy (CBT) or an active attention control. Six cytokine/chemokines in whole blood plasma (IL-6, IL-8, IL-10, IL-1β, and TNF-α) were assessed in a subset of trial participants at baseline, post-treatment, and at five months after treatment. We assessed relationships between baseline plasma inflammatory cytokine levels and self-reported symptoms, changes in cytokines over time, and how baseline cytokine levels may relate to clinically meaningful indicators of change following CBT. Results: Cytokine/chemokine levels did not significantly change over time. Higher levels of unstimulated IL-1β were associated with significantly worse clinical pain characteristics and greater degree of CBT treatment response. Discussion: This suggests that individuals with greater degrees of inflammation may derive more benefit from the self-regulation training, pain coping strategies, and cognitive reframing offered in CBT for pain.