A Case-Crossover Study of Urologic Chronic Pelvic Pain Syndrome Flare Triggers in the Mapp Research Network

Although many factors have been proposed to trigger symptom exacerbations ("flares") in patients with interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome, few studies have investigated these factors empirically. Therefore, we embedded a case-crossover study in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain longitudinal study to evaluate a range of patient-reported triggers.

Exposure to proposed triggers (diet, physical activities, sedentary behaviors, stress, sexual activities, infection-like symptoms, and allergies) was assessed by questionnaire a maximum of three times when participants reported flares and at three randomly-selected times. Participants' pre-flare to -non-flare exposures were compared by conditional logistic regression.

In our full analytic sample (n=292 participants), only two factors, recent sexual activity (odds ratio (OR)=1.44, 95% confidence interval (CI): 1.06-1.96) and symptoms of a urinary tract infection (OR=3.39, 95% CI: 2.02-5.68), which may overlap with those of flares, were associated with flare onset. In sub-analyses restricted to flares with specific, suspected triggers, additional positive associations were observed for some (certain dietary factors, abdominal muscle exercises, and vaginal infection-like symptoms and fever), but not other (e.g., stress) factors.

With the exception of sexual activity, our findings suggest that patient-reported triggers may be either individual/group-specific or may not contribute to flares. These findings suggest caution in following rigid, global flare prevention strategies and support additional research to develop evidence-based strategies.

The Journal of urology. 2017 Dec 27 [Epub ahead of print]

Siobhan Sutcliffe, Thomas Jemielita, H Henry Lai, Gerald L Andriole, Catherine S Bradley, J Quentin Clemens, Robert Gallop, Thomas M Hooton, Karl J Kreder, John N Krieger, John W Kusek, Jennifer Labus, M Scott Lucia, Sean Mackey, Bruce D Naliboff, Nancy A Robinson, Larissa V Rodriguez, Alisa Stephens-Shields, Adrie van Bokhoven, Kathleen Y Wolin, Yan Yan, Claire C Yang, J Richard Landis, Graham A Colditz, MAPP Research Network

Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO. Electronic address: ., Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA., Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO; Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO., Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO., Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA., Division of Neurology and Pelvic Reconstructive Surgery, Department of Urology, University of Michigan, Ann Arbor, MI., Division of Infectious Diseases, Department of Medicine, University of Miami School of Medicine, Miami, FL., Department of Urology, University of Iowa, Iowa City, IA., Department of Urology, University of Washington, Seattle, WA., National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD., 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., Department of Pathology, University of Colorado, Aurora, CO., Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA., Departments of Medicine, and Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, CA., Institute of Urology, University of Southern California, Beverly Hills, CA., ScaleDown, Chicago, IL., Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO.

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