To describe the frequency, intensity, and duration of urologic 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.
Current flare status ("urologic 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.
Of the 385 eligible participants, 24.2% reported no flares, 22.9% reported 1 flare, 28.3% 2-3 flares, and 24.6% ≥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 urologic 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 1-150 days (94.3% within-participant variability). In adjusted analyses, flares were more common, symptomatic, and/or longer-lasting in female participants and those with worse non-flare symptoms, bladder hypersensitivity, and chronic overlapping pain conditions.
In this foundational flare study, we found that pelvic pain and urologic symptom flares were common, but variable in frequency and manifestation. We also identified sub-groups of participants with more frequent, symptomatic, and/or longer-lasting flares for targeted flare management/prevention and further study. This article is protected by copyright. All rights reserved.
BJU international. 2019 Apr 23 [Epub ahead of print]
Siobhan Sutcliffe, Robert Gallop, H Henry Lai, Gerald L Andriole, Catherine S Bradley, Gisela Chelimsky, Thomas Chelimsky, J 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, J R Landis, MAPP Research Network
Division of Public Health Sciences, Department of Surgery and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO., 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 Obstetrics and Gynecology, Carver College of Medicine; and Department of Epidemiology, College of Public Health; University of Iowa, Iowa City, IA., Department of Pediatrics, Division of Pediatric Gastroenterology, Medical College of Wisconsin, Milwaukee, WI., Department of Neurology, Medical College of Wisconsin, Milwaukee, WI., Division of Neurourology and Pelvic Reconstructive Surgery, Department of Urology, University of Michigan, Ann Arbor, MI., Department of Urology, Carver College of Medicine, University of Iowa, Iowa City, IA., Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL., Departments of Surgery and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA., Department of Urology, University of Washington, Seattle, WA., 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., Institute of Urology, University of Southern California, Beverly Hills, CA.