Changes in whole body pain intensity and widespreadness during urologic chronic pelvic pain syndrome flares—Findings from one site of the MAPP study

Abstract

Objective To investigate changes in whole body pain during urologic chronic pelvic pain syndrome (UCPPS) flares. Materials and Methods UCPPS participants at one site of the multidisciplinary approach to the study of chronic pelvic pain research network reported their daily flare status and pain levels in 7 pelvic/genital and 42 extrapelvic body areas (scale = 0‐10) for 10 days at baseline and during their first flare. Linear mixed models and conditional logistic regression were used to investigate symptom changes during flares. Analyses were stratified by chronic overlapping pain condition (COPC) status. Results Fifty‐five out of 60 participants completed the study, 27 of whom provided information on both nonflare (n = 281) and flare (n = 208) days. Pelvic/genital pain intensity (mean change = 3.20 of 10) and widespreadness (mean = 1.48) increased significantly during flares for all participants (all P interaction > .1), whereas extrapelvic pain intensity increased significantly only among participants with COPCs (mean = 2.09; P interaction < .0001). Pelvic/genital and extrapelvic pain also varied on nonflare days but symptom fluctuations were generally ≤1 point (80.0%‐100% of participants). Increases of ≥2 points in pelvic/genital pain intensity (odds ratio (OR) = 22.0, 95% confidence interval (CI) = 4.0‐118.6) and ≥1 point in urination‐related pain (OR = 9.10, 95% CI = 1.74‐47.7) were independently associated with flare onset for all participants. Conclusion Our observations of extrapelvic pain increases during flares for patients with COPCs and our independent associations between pelvic/genital/urination‐related pain intensity and flare onset may provide insight into mechanisms underlying flare development (eg, common biologic pathways between UCPPS phenotypes and flares), flare management (eg, local vs systemic therapies by COPC status), and patient flare definitions.

Microbiota of Chronic Prostatitis/Chronic Pelvic Pain Syndrome are Distinct from Interstitial Cystitis/Bladder Pain Syndrome

“…Because UCPPS mechanisms and therapies remain elusive, NIDDK launched their flagship effort in pelvic pain, the Multi-Disciplinary Approach to the Study of Chronic Pelvic Pain Research Network (MAPP, [7, 8]) supporting deep phenotyping of UCPPS patients and mechanistic studies in clinically relevant models. Historically, UCPPS were viewed as end-organ conditions of the prostate or bladder, but MAPP findings suggest a centralized component of pelvic pain from fMRI signatures of UCPPS, altered cognitive function, and patient subsets exhibiting differential pain “widespreadness” [9]. Together, these findings suggest a systemic influence on UCPPS.…”

Urologic Chronic Pelvic Pain Syndrome Flares: A Comprehensive, Systematic Review and Meta-Analysis of the Peer-Reviewed Flare Literature

“…9,[11][12][13] Participants also subdivided their flares into "minor" or "moderate" flares vs "major" flares and other similar terms. 9,13,15 Manifestation Twenty-one articles provided information on flare manifestation, 8,9,12,13,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] although only 6 documented participants' experiences prospectively over time. [21][22][23]25,28,29 Most participants reported at least 1 flare during their lifetime and/or symptom fluctuations (57%-100%; Supplementary Appendix Tables 1 and 2, https://www.jurology.com).…”

“…9,13,15 Manifestation Twenty-one articles provided information on flare manifestation, 8,9,12,13,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] although only 6 documented participants' experiences prospectively over time. [21][22][23]25,28,29 Most participants reported at least 1 flare during their lifetime and/or symptom fluctuations (57%-100%; Supplementary Appendix Tables 1 and 2, https://www.jurology.com). However, typical or recent flare frequency varied considerably across studies, driven largely by the stringency of the flare definition and inclusion criteria of the study.…”

“…With respect to symptom intensity, 14 articles provided data, 8,9,12,13,19,20,22,24,25,[27][28][29]32,33 half of which were conducted in the MAPP Network 9,13,24,25,28,29,33 and only 4 of which documented participants' symptoms prospectively. 22,25,28,29 These articles indicated that pelvic pain and urologic symptom intensity were elevated during flares (mean [ 5.2-8.8 [median [ 8.0] for pain 8,20,22,24,25,[27][28][29]33 and mean [ 3.5-5.6 for urologic symptoms out of 10 24,25,28,29 ) and greater than nonflare or baseline symptoms by a mean of 2.6 to 5.8 points (median [ 4.0) for pain 22,25,28,29,33 and a mean of 1.7 to 2.2 points for urologic symptoms (Supplementary Appendix Table 1, https://www.jurology. com).…”

Validation of the ‘Pelvic Pain Map’: a new self‐assessment tool for chronic pelvic pain localisation

“…This is particularly true in CPPS, which lack reproducible phenotypic descriptions of pain associated with common problems such as urination, ejaculation, ovulation, and dyspareunia. Research groups such as The Multidisciplinary Approach to Pelvic Pain (MAPP) Research Network have adapted and used the CHOIR body pain diagram to identify distinct groups of urological CPPS (UCPPS) patients with pain localised to different organs within the pelvis, the pelvis alone, or the pelvis along with other body regions [22,23].…”