OBJECTIVE: To investigate whether yoga and meditation added to usual care improves treatment response in women with interstitial cystitis-bladder pain syndrome.
METHODS: This randomized trial compared women with interstitial cystitis-bladder pain syndrome receiving standard care alone (control group) with those receiving standard care plus meditation and yoga (mind-body group). Standard care was defined as behavioral changes or medications recommended by the American Urological Association. Individuals in the control group received standard care, and those in the mind-body group received standard care augmented with a commercially available meditation application and standardized yoga tutorial video. Both groups continued their current interstitial cystitis-bladder pain syndrome standard care treatments. The primary outcome was the modified GRA (Global Response Assessment), comparing responders (moderately, markedly improved) with nonresponders at 12 weeks. On power analysis assuming a=5% and ß=80%, a sample size of 82 participants was required to find 30% difference on the GRA between groups. Weekly GRA scores over 12 weeks were also compared. Secondary outcomes included ICPI (Interstitial Cystitis Problem Index)/ICSI (Interstitial Cystitis Symptom Index), pain, pain interference, anxiety/depression, and self-efficacy scores and treatment escalation over 12 weeks.
RESULTS: Among 97 randomized participants (49 mind-body group, 48 control group), groups did not differ in characteristics or symptoms at baseline. The mind-body group had more GRA responders compared with the control group at 12 weeks (31/43 [72.1%] vs 10/39 [25.6%], relative risk [RR] 2.8, 95% CI, 1.6-4.6), corroborated by superior weekly GRA results over 12 weeks. The mind-body group had superior beneficial change on the ICPI (RR 1.8, 95% CI, 0.5-3.1), ICSI (RR 1.9, 95% CI, 0.2-3.6), and pain (RR 1.4, 95% CI, 0.4-2.5) scores than the control group at 12 weeks. The mind-body group required less treatment escalation than the control group (2/45 [4.4%] vs 14/42 [33.3%], RR 0.13, 95% CI, 0.03-0.55).
CONCLUSION: The addition of meditation and yoga to standard interstitial cystitis-bladder pain syndrome care was associated with improved treatment response and required fewer additional interventions compared with standard care alone.
CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT04820855.
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This article provides useful evidence regarding interstitial cystitis-bladder pain syndrome treatment. The results show that the adding meditation and yoga to standard interstitial cystitis-bladder pain syndrome care was associated with improved treatment response. Accessible treatments, increasingly patient-centered rather than hospital or clinic based, offer unique alternative evidence-based interventions requested by patients. Future work is needed to verify the findings and generalizability of this study. Ideally, a randomized trial should be done in a larger population of women for a longer duration with rigorous masking of participant to interventions.
Interesting results. It would be difficult to reproduce these findings for other patients due to a lack of information about the details of the intervention, which are not universal or standardised strategies and possibly have high variability.
Since chronic pain conditions are so difficult to treat, it's helpful to know that healthy lifestyle changes really do work. We all should be emphasizing these methods more in our clinics.