Guided Imagery for Women with Interstitial Cystitis : Results of a Prospective , Randomized Controlled Pilot Study

Introduction: In the United States, more than 1 million women and men are affected with interstitial cystititis (IC), which is a clinical syndrome involving urinary urgency, frequency, and pelvic pain. A review of the literature revealed that there are no studies showing the effect of guided imagery in women with IC. The purpose of this clinical investigation was to explore the effect of guided imagery on pelvic pain and urinary symptoms in women with IC symptoms. Methodology: Thirty (30) women with diagnosed IC were randomized into 2 equal groups. One group (treatment) listened to a 25-minute guided imagery compact disc (CD), that was created specifically for women with pelvic pain and IC, twice a day for 8 weeks. The control group rested for 25 minutes twice daily for 8 weeks. Because no guided imagery CDs specifically for women with IC were found on the commercial market, the authors created a script and recorded the CD specifically for women with IC and pelvic pain. The focus of this guided imagery CD was on healing the bladder, relaxing the pelvic-floor muscles, and quieting the nerves specifically involved in IC. Baseline and end-of-study assessment questionnaires (Interstitial Cystitis Symptom Index & Problem Index [IC-SIPI], IC Self-Efficacy Scale, a visual analogue [VAS] scale for pain, and a global response assessment [GRA]), 2-day voiding diaries, and 24-hour pain diaries were completed by the subjects and were evaluated using SPSS (Chicago, IL). Results: More than 45% of the treatment group were responders to guided imagery therapy noting a moderate or marked improvement on the GRA. Pain scores and episodes of urgency significantly decreased in the treatment group. Responders had significant reductions in IC-SIPI scores (problem index, p 0.006; symptom index, p 0.004). In addition, responders on the GRA had significant (p 0.039) improvements in mean pain scores from 5.50 to 2.57 at the end of the study in contrast to the nonresponders, whose pain levels remained the same (4.89 to 4.39). Conclusions: This is the first study providing preliminary data supporting the use of guided imagery as a potential therapy for IC. Guided imagery may be a useful tool to offer women with IC for pain and IC symptom management. It is an intervention without negative side-effects, is readily available, and shows a trend toward improvement of IC symptoms. 53 William Beaumont Hospital, Department of Urology, Royal Oak, MI. Ministrelli Program for Urology Research and Education (MPURE). *Dr. Peters is a consultant for Medtronic, Minneapolis, MN, and Indevus, Lexington, MA, and a consultant/investigator for Advanced Bionics, Valencia, CA. †Dr. Diokno is an investigator and consultant for Ortho Urology, GSK, Medtronic, and Eli Lilly; a consultant for Advanced Urologic Devices, Astellas Pharma, and Allergan; and an investigator for Allergan, Life Tech. INTRODUCTION Guided imagery uses words to direct one’s thoughts and attention to imagined visual, auditory, tactile, or olfactory sensations to elicit the psychologic and physiologic response of relaxation.1 The physiologic effects of guided imagery may be related to the Gate Control Theory of pain by Melzack and Wall.2 This theory states that only one impulse can travel up the spinal cord to the brain at a time. If this pathway is occupied with other thoughts, then the sensations of pain cannot be sent to the brain, and therefore the pain is reduced. Another theory supports the impact of guided imagery on endorphin release from the brain. Endorphins are the body’s natural analgesics. The endorphins released in response to using guided imagery promote relaxation, decreased pain, and an increased pain threshold. This activates the parasympathetic nervous system to decrease blood pressure, respirations, and heart rate and increase relaxation.3 Guided imagery has demonstrated efficacy in reducing pain related to many conditions including cancer pain,4 chronic low-back pain,5 and postoperative pain.6 A review of 46 guided imagery intervention studies reported that 87% of these studies found that guided imagery resulted in improvements in the psychologic or physiologic outcomes examined. However, there is a need for more randomized, controlled clinical studies to provide findings that lead to evidence-based practice in a variety of areas.7 In urology, many people worldwide suffer with interstitial cystitis (IC) or painful bladder syndrome, which is a chronic condition. In the United States, more than 1 million women are affected as well as a significant number of men.8 IC is a clinical syndrome of urinary urgency, frequency, and pelvic pain that may occur in a variety of locations such as the lower abdomen and back, as well as the inguinal, urethral, vaginal, or suprapubic areas. Urinary frequency may be up to 60 times per day and every 20–30 minutes during the night. This can lead to chronic sleep deprivation and depression.9 Currently, in women in the United States, the incidence of IC is 52–67 cases per 100,000.10 IC is three times more prevalent in the United States than in Europe;9 however, there are differences in diagnostic criteria that may account for this variation in prevalence. The majority of women with IC are Caucasian, with a median age at diagnosis of 42–46 years. Chronic pain, particularly neuropathic pain, may alter one’s emotional well-being, family and social relationships, and ability to work.11 It has been hypothesized that patients with IC who have been unable to obtain adequate relief from medical remedies would value a psychotherapeutic intervention that could diminish some of their pain.12 In general, women who used biofeedback, self-hypnosis, heat, or cold to alleviate mild-to-moderate pain found the effectiveness of these techniques to be comparable to the effectiveness of medications, including narcotics.13 However, a review of the literature revealed that there are no studies showing the effect of guided imagery in women with IC. The purpose of this clinical investigation was to explore the effect of guided imagery on pelvic pain and urinary symptoms in women with IC.