SUFU 2021: Subgrouping of Patients With Urologic Chronic Pelvic Pain Based on Pain and Urinary Symptoms: A Mapp Network Analysis

( Baseline data in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network Symptom Patterns Study (SPS) were used to corroborate the use of two related, but separate primary symptom components of the Urologic Chronic Pelvic Pain Syndrome (UCPPS) using items from the Genitourinary Pain Index (GUPI) and the Interstitial Cystitis Symptom Index (ICSI), derived from the previous MAPP Epidemiology Phenotyping Study (EPS). Urinary Symptom Severity (USS) is composed of items related to urinary urgency/frequency while the other is composed of items reflective of pelvic pain severity (Pelvic Pain Severity, PPS).

This was reliability and validation data for subgrouping patients on these two dimensions. 578 UCPPS research participants (193M, 385F) were classified into mild, moderate, or severe tertiles of USS and PPS at baseline (week 4) and these subgroup designations were examined for stability (reliability) using Interclass Correlations Coefficients (ICCs) over four weekly assessments prior to the baseline visit. The tertile classifications were then examined for convergent and divergent validity by comparing subgroups across multiple UCPPS clinical measures using a general linear model (GLM) approach. Sex was included as a potential moderator of these relationships. Both USS and PPS classifications were stable over the four assessments (ICC=0.78 and 0.67, respectively). USS compared to PPS was more strongly associated with urge during a laboratory bladder filling procedure and heightened sensory sensitivity. PSS compared to USS was more strongly related to pelvic floor tenderness on exam, the spread of genital/pelvic pain, and mental health quality of life (QOL). Both dimensions were independently associated with physical health QOL, widespread non-urological symptoms, and neuropathic-like sensations.

This analysis further supports the validity and utility of a two-dimensional, pelvic pain and urinary symptoms assessment framework for UCPPS. The use of a mild, moderate or severe classification for each dimension provides a validated method for subgrouping patients in clinical practice and clinical trials.

Presented by: Bruce D. Naliboff, James W. Griffith, Robert Moldwin, Kenneth Locke, Jr, Andrew D. Schrepf, Catherine S. Bradley, Siobhan Sutcliffe, David Williams, H. Henry Lai, John N. Krieger, J. Quentin Clemens, Michel A. Pontari, Larissa V. Rodriguez, Bayley J. Taple, J. Richard Landis, G. Oppenheimer Center for Neurobiology of Stress and Resilience, Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, Zucker School of Medicine at Hofstra-Northwell, Pelvic Pain Treatment Center, The Arthur Smith Institute for Urology, Lake Success, New York, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, Department of Urogynecology, University of Iowa Hospitals Clinics, Iowa City, IA, Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, Chronic Pain Fatigue Research Center, University of Michigan, Ann Arbor, Michigan, Division of Urologic Surgery (Urology) and Anesthesiology, Washington University School of Medicine, St. Louis, MO, Department of Urology, University of Washington, Seattle, Washington, Department of Urology, University of Michigan, Ann Arbor, Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, Institute of Urology at the University of Southern California, Beverly Hills, California

Written by: Diane K. Newman, DNP, CRNP, FAAN, BCB-PMD, Nurse Practioner and Co-Director, Penn Center for Continence and Pelvic Health Adjunct Professor of Urology in Surgery during the 2021 Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Winter Meeting.

Griffith JW, et al., Pain and urinary symptoms should not be combined into a single score: Psychometric findings from the MAPP Research Network. J Urol. 2016 Apr;195,949-54