Chronic pain and Post-Traumatic Stress Disorder (PTSD) frequently coexist, with up to 50% of individuals with PTSD experiencing chronic pain. [1] While Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) is classified as a chronic pain condition, its association with PTSD remains underexplored. [2] Prior studies have linked IC/BPS to increased childhood trauma and PTSD symptoms; however, these studies often fail to account for a formal PTSD diagnosis. [3] This distinction is critical, as PTSD is known to exacerbate chronic pain conditions, potentially altering the clinical course and treatment response of IC/BPS. This study aims to quantify the risk of IC/BPS development in individuals with PTSD, providing valuable insights for early diagnosis, targeted treatment, and improved management strategies.

This study utilized a retrospective analysis of a large healthcare database to investigate the association between PTSD and the subsequent development of IC/BPS. Two cohorts were carefully selected and propensity-matched based on key demographic variables, including age, sex, race, and ethnicity, to minimize potential confounding factors. The first cohort consisted of individuals diagnosed with PTSD who had no prior history of IC/BPS, while the second cohort included individuals without PTSD or IC/BPS, serving as the control group. 

To ensure adequate follow-up and data reliability, all individuals included in the study were required to have at least one clinical visit within the year following their initial assessment and another follow-up visit within a three-to-five-year window. Both cohorts were monitored over a five-year period, with IC/BPS diagnoses identified using standardized diagnostic coding. The primary outcome of interest was the incidence of IC/BPS at multiple time points throughout the follow-up period. The relative risk of developing IC/BPS in the PTSD cohort compared to the control group was assessed, and statistical analyses were performed to determine the significance of this association.

Rates of IC/BPS diagnosis at 1-year, 3-years, and 5-years revealed a significantly increased risk of IC/BPS in patients with PTSD as compared to their matched counterparts without PTSD​. The 1-year odds ratio was found to be 2.404, 95% CI [1.966, 2.941]​. The 3-year odds ratio was 2.293, 95% CI [2.015, 2.610]​, and the 5-year odds ratio was 2.188, 95% CI [1.968, 2.432].

The analysis revealed a significant association between PTSD and an increased likelihood of developing IC/BPS (Figure 1). Across all time intervals, individuals with PTSD exhibited a substantially higher risk of being diagnosed with IC/BPS when compared to their matched counterparts without PTSD. This elevated risk persisted over time, demonstrating a consistent trend that suggests PTSD may be a contributing factor in the pathogenesis of IC/BPS.

This large-scale, propensity-matched analysis demonstrates a significant association between PTSD and an increased risk of IC/BPS development. Given these findings, urologists, mental health specialists, and primary care providers should maintain a high index of suspicion for IC/BPS in PTSD patients. Routine screening for PTSD in IC/BPS patients may improve diagnosis and management. Additionally, these results highlight the need for trauma-informed care approaches in urology, as addressing underlying PTSD may influence symptom severity and treatment outcomes.

Gasperi, M., Afari, N., Goldberg, J., Suri, P., & Panizzon, M. S. (2021). Pain and trauma: The role of criterion a trauma and stressful life events in the pain and PTSD relationship. The Journal of Pain, 22(11), 1506–1517. https://doi.org/10.1016/j.jpain.2021.04.015
McKernan, L. C., Walsh, C. G., Reynolds, W. S., Crofford, L. J., Dmochowski, R. R., & Williams, D. A. (2017). Psychosocial co-morbidities in interstitial cystitis/bladder pain syndrome (IC/BPS): A systematic review. Neurourology and Urodynamics, 37(3), 926–941. https://doi.org/10.1002/nau.23421
Naliboff, B. D., Stephens, A. J., Afari, N., Lai, H., Krieger, J. N., Hong, B., Lutgendorf, S., Strachan, E., & Williams, D. (2015). Widespread psychosocial difficulties in men and women with Urologic Chronic Pelvic Pain Syndromes: Case-control findings from the multidisciplinary approach to the study of Chronic Pelvic Pain Research Network. Urology, 85(6), 1319–1327. https://doi.org/10.1016/j.urology.2015.02.047