Ecological momentary assessment of pelvic pain and urinary urgency variability in urologic chronic pelvic pain syndrome and their association with illness impact and quality of life: Findings from the multidisciplinary approach to the study of chronic pel

Purpose: This study tested the hypothesis that ecological momentary assessment (EMA) of pelvic pain (PP) and urinary urgency (UU) would reveal unique Urologic Chronic Pelvic Pain Syndrome (UCPPS) phenotypes that would be associated with disease specific quality of life (QOL) and illness impact metrics (IIM).

Materials and methods: A previously validated smartphone app (M-app) was provided to willing Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) participants. M-app notifications were sent 4-times daily for 14 days inquiring about PP and UU severity. A clustering algorithm that accounted for variance placed participants into PP and UU variability. clusters. Associations between clusters and QOL and IIM were then determined.

Results: A total of 204 participants enrolled in the M-app study (64% female). M-app compliance was high (median 63% of surveys). Cluster analysis revealed k = 3 (high, low, none) PP clusters and k = 2 (high, low) UU clusters. When adjusting for baseline pain severity, high PP variability, but not UU variability, was strongly associated with QOL and IIM; specifically worse mood, worse sleep, and higher anxiety. UU and PP clusters were associated with each other (p < 0.0001), but a large percentage (33%) of patients with high PP variability had low UU variability.

Conclusions: PP variability is an independent predictor of worse QOL and more severe IIM in UCPPS participants after controlling for baseline pain severity and UU. These findings suggest alternative pain indices, such as pain variability and unpredictability, may be useful adjuncts to traditional measures of worst and average pain when assessing UCPPS treatment responses.

Bradley A Erickson,1 James W Griffith,2 Guo Wensheng,3 You Mengying,3 Ted Herman,4 Catherine S Bradley,5 J Quentin Clemens,6 John T Farrar,7 Priyanka Gupta,6 Karl J Kreder,1 H Henry Lai,8 Bruce D Naliboff,9 Diane K Newman,10 Larissa V Rodriguez,11 Theresa Spitznagle,12 Siobhan Sutcliffe,13 Suzette E Sutherland,14 Bayley J Taple,2 J Richard Landis15

  1. Department of Urology, University of Iowa, Iowa City, Iowa, USA.
  2. Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
  3. Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
  4. Department of Computer Sciences, University of Lowa College of Liberal Arts and Sciences, Iowa City, Iowa, USA.
  5. Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa, USA.
  6. Department of Urology, University of Michigan, Ann Arbor, Michigan, USA.
  7. Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
  8. Division of Urologic Surgery, Department of Surgery, and Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA.
  9. G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at the University of California, Los Angeles, California, USA.
  10. Penn Center for Continence and Pelvic Health, Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
  11. Department of Urology, Cornell University, New York, New York, USA.
  12. Program in Physical Therapy, Washington University School of Medicine, St Louis, Missouri, USA.
  13. Division of Public Health Sciences, Department of Surgery and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA.
  14. Department of Urology, University of Washington, Seattle, Washington, USA.
  15. Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Source: Erickson BA, Griffith JW, Wensheng G, et al. Ecological momentary assessment of pelvic pain and urinary urgency variability in urologic chronic pelvic pain syndrome and their association with illness impact and quality of life: Findings from the multidisciplinary approach to the study of chronic pelvic pain symptom patterns study. Neurourol Urodyn. 2024 Jan 22. doi: 10.1002/nau.25363.