A longitudinal analysis of urological chronic pelvic pain syndrome flares in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network

Siobhan Sutcliffe; Robert Gallop; Hing Hung Henry Lai; Gerald L Andriole; Catherine S Bradley; Gisela Chelimsky; Thomas Chelimsky; James Quentin Clemens; Graham A Colditz; Bradley Erickson; James W Griffith; Jayoung Kim; John N Krieger; Jennifer Labus; Bruce D Naliboff; Larissa V Rodriguez; Suzette E Sutherland; Bayley J Taple; John Richard Landis

doi:10.1111/bju.14783

A longitudinal analysis of urological chronic pelvic pain syndrome flares in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network

BJU Int. 2019 Sep;124(3):522-531. doi: 10.1111/bju.14783. Epub 2019 May 29.

Authors

Siobhan Sutcliffe¹, Robert Gallop², Hing Hung Henry Lai^{3

4}, Gerald L Andriole³, Catherine S Bradley^{5

6

7}, Gisela Chelimsky⁸, Thomas Chelimsky⁹, James Quentin Clemens¹⁰, Graham A Colditz¹, Bradley Erickson⁷, James W Griffith¹¹, Jayoung Kim¹², John N Krieger¹³, Jennifer Labus¹⁴, Bruce D Naliboff¹⁴, Larissa V Rodriguez¹⁵, Suzette E Sutherland¹³, Bayley J Taple¹¹, John Richard Landis²

Affiliations

¹ Division of Public Health Sciences, Department of Surgery and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
² Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
³ Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
⁴ Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA.
⁵ Department of Obstetrics and Gynecology, Carver College of Medicine University of Iowa, Iowa City, IA, USA.
⁶ Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA.
⁷ Department of Urology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
⁸ Department of Pediatrics, Division of Pediatric Gastroenterology, Medical College of Wisconsin, Milwaukee, WI, USA.
⁹ Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.
¹⁰ Division of Neurourology and Pelvic Reconstructive Surgery, Department of Urology, University of Michigan, Ann Arbor, MI, USA.
¹¹ Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
¹² Departments of Surgery and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
¹³ Department of Urology, University of Washington, Seattle, WA, USA.
¹⁴ Oppenheimer Center for Neurobiology of Stress and Resilience and Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, CA, USA.
¹⁵ Institute of Urology, University of Southern California, Beverly Hills, CA, USA.

Abstract

Objective: To describe the frequency, intensity and duration of urological chronic pelvic pain syndrome symptom exacerbations ('flares'), as well as risk factors for these features, in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Epidemiology and Phenotyping longitudinal study.

Participants and methods: Current flare status ('urological or pelvic pain symptoms that are much worse than usual') was ascertained at each bi-weekly assessment. Flare characteristics, including start date, and current intensity of pelvic pain, urgency and frequency (scales of 0-10), were assessed for participants' first three flares and at three randomly selected times when they did not report a flare. Generalized linear and mixed effects models were used to investigate flare risk factors.

Results: Of the 385 eligible participants, 24.2% reported no flares, 22.9% reported one flare, 28.3% reported 2-3 flares, and 24.6% reported ≥4 flares, up to a maximum of 18 during the 11-month follow-up (median incidence rate = 0.13/bi-weekly assessment, range = 0.00-1.00). Pelvic pain (mean = 2.63-point increase) and urological symptoms (mean = 1.72) were both significantly worse during most flares (60.6%), with considerable within-participant variability (26.2-37.8%). Flare duration varied from 1 to 150 days (94.3% within-participant variability). In adjusted analyses, flares were more common, symptomatic, and/or longer-lasting in women and in those with worse non-flare symptoms, bladder hypersensitivity, and chronic overlapping pain conditions.

Conclusion: In this foundational flare study, we found that pelvic pain and urological symptom flares were common, but variable in frequency and manifestation. We also identified subgroups of participants with more frequent, symptomatic, and/or longer-lasting flares for targeted flare management/prevention and further study.

Keywords: epidemiology; interstitial cystitis; prostatitis; symptom flare-up.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adult
Chronic Pain* / epidemiology
Chronic Pain* / etiology
Cystitis, Interstitial / complications
Cystitis, Interstitial / epidemiology
Female
Humans
Longitudinal Studies
Male
Pelvic Pain* / epidemiology
Pelvic Pain* / etiology
Prostatitis / complications
Prostatitis / epidemiology
Risk Factors

Abstract

Publication types

MeSH terms

Grants and funding