Temporal Relationships Between Pain, Mood and Urinary Symptoms in Urologic Chronic Pelvic Pain Syndrome (UCPPS): A MAPP Network Study.

To determine the time-lagged, bidirectional relationships among clinical variables of pelvic pain, urinary symptoms, negative mood, non-pelvic pain and quality of life (QOL) in men and women with UCPPS, incorporating interstitial cystitis/bladder pain syndrome (IC/BPS) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).

204 female and 166 male patients were assessed up to 24 times over a 48-week period on the five primary outcomes. A lagged autoregressive analysis was applied to determine the directional relationship of one variable to another two weeks later, beyond that of the concurrent relationships at each time point and autocorrelations and trends over time.

The results show clear evidence for a bidirectional positive relationship between changes in pelvic pain severity and urinary symptom severity. Increases in either variable predicted significant increases in the other two weeks later, beyond that explained by their concurrent relationship at each time point. Pelvic pain and to a lesser degree urinary frequency also showed similar bidirectional relationships with negative mood and decreased QOL. Interestingly, neither pelvic pain or urinary symptom severity showed lagged relationships with non-pelvic pain severity.

Results document for the first time specific short-term positive feedback between pelvic pain and urinary symptoms, and between symptoms of UCPPS, mood, and QOL. The feedforward aspects of these relationships can facilitate a downward spiral of increased symptoms and worsening psychosocial function, and suggest the need for multifaceted treatments and assessment to address this possibility in individual patients.

The Journal of urology. 2021 Feb 04 [Epub ahead of print]

Bruce D Naliboff, Andrew D Schrepf, Alisa J Stephens-Shields, J Quentin Clemens, Michael A Pontari, Jennifer Labus, Bayley J Taple, Larissa V Rodriguez, Eric Strachan, James W Griffith

University of California Los Angeles, Los Angeles, California., University of Michigan, Ann Arbor, Michigan., University of Pennsylvania, Philadelphia, Pennsylvania., Temple University, Philadelphia, Pennsylvania., Northwestern University, Evanston, Illinois., University of Southern California, Los Angeles, California., University of Washington, Seattle, Washington.

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