Psychosocial Mediators and Moderators of the Catastrophizing-Pain Relationship in Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS)
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Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) is a urologic chronic pelvic pain syndrome without consensus on its etiology or treatment. Present biomedical outcomes for IC/BPS remain poor. There is growing recognition within the medical field of the significant role psychosocial factors play in the chronic pain experience. Catastrophizing, behavioural coping strategies, and depressive symptomology are all noted for their negative impact on chronic pelvic pain outcomes. In particular, the relationship between catastrophizing and pain, long recognized in other chronic pain populations, has recently been highlighted in IC/BPS research. The primary aim of this study was to identify the conditional processes through which catastrophizing predicts pain. Using the transactional model of stress and coping and the fear of re-injury model as theoretical frameworks, a moderated multiple-mediation model was tested which predicted that illness-focused and wellness-focused behavioural coping strategies mediate the relationship between catastrophizing and pain, and that these mediating effects were stronger among individuals with higher levels of depressive symptomology. Female patients diagnosed with IC/BPS (N=341; 49.77 ± 14.49 years) were recruited from tertiary care urology clinics in Canada, USA, Taiwan, Denmark, and India. Participants completed questionnaires measuring levels of pain, catastrophizing, behavioural coping strategy usage, and depressive symptomology. Illness-focused behavioural coping strategies were found to mediate the relationship between catastrophizing and pain (both sensory and affective). Additionally, depressive symptomology moderated the mediating effect of illness-focused behavioural coping on the relationship between catastrophizing and affective pain. The relationships between pain, catastrophizing, behavioural coping strategies, and depressive symptomology are discussed in relation to the extant chronic pain literature, along with clinical implications, limitations, and areas for future research.