Characterization of Whole Body Pain in Urological Chronic Pelvic Pain Syndrome at Baseline: A MAPP Research Network Study

Abstract

Purpose We characterized the location and spatial distribution of whole body pain among patients with urologic chronic pelvic pain syndrome (UCPPS) using a body map; and compared the severity of urinary symptoms, pelvic pain, non-pelvic pain, and psychosocial health among patients with different pain patterns. Methods 233 women and 191 men with UCPPS enrolled in a multi-center, one-year observational study completed a battery of baseline measures, including a body map describing the location of pain during the past week. Participants were categorized as having “pelvic pain only” if they reported pain in the abdomen and pelvis only. Participants who reported pain beyond the pelvis were further divided into two sub-groups based on the number of broader body regions affected by pain: an “intermediate” group (1–2 additional regions outside the pelvis) and a “widespread pain” group (3–7 additional regions). Results Of the 424 enrolled patients 25% reported pelvic pain only, and 75% reported pain beyond the pelvis of which 38% reported widespread pain. Participants with greater number of pain locations had greater non-pelvic pain severity (p<0.0001), sleep disturbance (p=0.035), depression (p=0.005), anxiety (p=0.011), psychological stress (p=0.005), negative affect scores (p=0.0004), and worse quality of life (p≤0.021). No difference in pelvic pain and urinary symptom severity were observed by increasing pain distribution. Conclusions Three-quarters of men and women with UCPPS reported pain outside the pelvis. Widespread pain was associated with greater severity of non-pelvic pain symptoms, poorer psychosocial health and worse quality of life, but not worse pelvic pain or urinary symptoms.

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

“…Our novel observation of two flare patterns, one with and one without concomitant increases in extrapelvic pain, is consistent with the broader hypothesis of the existence of at least two distinct UCPPS phenotypes . Moreover, it also suggests that the pathologies underlying these two phenotypes may contribute to flare pathology.…”

“…Whole body pain was investigated by asking participants to mark areas where they felt “pain or discomfort” that day and to indicate their average level of pain in each marked area (scale = 0‐10) on two whole body maps (front and back) modified from the Brief Pain Inventory (BPI; Figure A1). Similar to previous MAPP analyses, we grouped the 42 extrapelvic areas (all areas except for 14‐16) into the following seven regions: back, head, right leg, left leg, right arm, left arm, and trunk . For pelvic and genital pain, participants reported their average levels of pain or discomfort in six (male) or seven (female) pelvic/genital areas (scale = 0‐10), using sex‐appropriate diagrams modified from the BPI (Figure A2).…”

“…Finally, to identify high pain burden days, we categorized each day as having a high cumulative pain level, using the 80th percentile of all cumulative pain values to define a high level (≥12 for extrapelvic pain and ≥18 for pelvic/genital pain). These cutoff points were selected to approximate the percentage of participants defined as having widespread pain in our previous trans‐MAPP body map analysis . Sensitivity analyses using a cutoff point of the 90th percentile were also performed.…”

Phenotypic features of central sensitization

“…Currently more studies are needed to identify if there are unique affective characteristics that differentiate COPCs (and by implication CS) from other forms of chronic pain. As mentioned previously, the study of UCPPS patients demonstrated that greater wide-spreadedness of pain was associated with worse depressive and anxiety symptoms (as measured by the HADS) and worse mental health overall (as measured by the SF12) for both males and females (Lai et al, 2017). …”

“…In this study, 75% reported pain beyond the pelvic region, with 38% reporting pain in more than 3 sites simultaneously. Those with broader pain distributions demonstrated significantly poorer scores on the other elements of the SPACE symptom cluster (Lai et al, 2017). Similar findings have been reported in the context of TMD (Slade et al, 2013) and FM (Cassisi et al, 2014).…”