Abstract
BackgroundInterstitial Cystitis (IC) is a debilitating disorder of the bladder, with a multifactorial and poorly understood origin dealing with microcirculation repeated damages. Also Fibromyalgia (FM) is a persistent disorder whose etiology is not completely explained, and its theorized alteration of pain processing can compromise the quality of life. Both these conditions have a high incidence of conventional therapeutic failure, but recent literature suggests a significant beneficial response to Hyperbaric Oxygen Therapy (HBOT). With this study, this study we evaluated the effects of HBOT on quality of life, symptoms, urodynamic parameters, and cystoscopic examination of patients suffering from both IC and FM.MethodsWe structured an observational clinical trial design with repeated measures (questionnaires, urodynamic test, and cystoscopy) conducted before and 6 months after a therapeutic protocol with hyperbaric oxygen for the treatment of patients suffering from both IC and FM. Patients were exposed to breathing 100% oxygen at 2 atm absolute (ATA) in a multiplace pressure chamber for 90 min using an oro-nasal mask. Patients undertook a cycle of 20 sessions for 5 days per week, and a second cycle of 20 sessions after 1 week of suspension.ResultsTwelve patients completed the protocol. Changes after HBOT were not significant, except for hydrodistension tolerance (mean pre-treatment: 409.2 ml; mean post-treatment: 489.2 ml; p < 0.05). A regression of petechiae and Hunner’s ulcers was also noted 6 months after the completion of HBOT.ConclusionsOur study showed no improvement of symptoms, quality of life, and urodynamic parameters, except for hydrodistension, and a slight improvement in cystoscopic pattern. However, to date, we could not demonstrate the significance of overall results to justify the use of HBOT alone in patients with IC and FM. This observation suggests that additional studies are needed to better understand if HBOT could treat this subset of patients.Trial registrationNCT03693001; October 2, 2018. Retrospectively registered.
Highlights
Interstitial Cystitis (IC) is a debilitating disorder of the bladder, with a multifactorial and poorly understood origin dealing with microcirculation repeated damages
The inclusion criteria were: (a) pain in bladder filling that improves with urination; (b) pain; (c) presence of glomerulation and positive histologic findings at biopsy [18]; (d) reduced capacity; (e) increased visceral sensitivity; (f) normal or reduced compliance; (g) symptoms refractory to conventional therapy; and (h) diagnosis of FM according to the 2010 American College of Rheumatology guidelines [15, 16]
Patients involved in the study read and signed an informed consent, were free to renounce the study at any time, and every precaution was taken to protect their privacy
Summary
Interstitial Cystitis (IC) is a debilitating disorder of the bladder, with a multifactorial and poorly understood origin dealing with microcirculation repeated damages. Fibromyalgia (FM) is a persistent disorder whose etiology is not completely explained, and its theorized alteration of pain processing can compromise the quality of life. Both these conditions have a high incidence of conventional therapeutic failure, but recent literature suggests a significant beneficial response to Hyperbaric Oxygen Therapy (HBOT). The possible presence of infection (due to urothelium damage), an increase in void frequency, and a pain resistant to analgesia are early symptoms that make the diagnosis more challenging because of overlapping with those present in bacterial cystitis and several other diseases [8]. The effectiveness of most treatments does not exceed 60%, and symptoms return even after a period of improvement or recovery [9]
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