Pain and urinary symptoms should not be combined into one score: Psychometric findings from the Multi-disciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network

PURPOSE - The purpose of this study was to create symptom indices - that is, scores derived from questionnaires - to accurately and efficiently measure symptoms of interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome, collectively referred to as urologic chronic pelvic pain syndromes (UCPPS).

We created these indices empirically, by investigating the structure of symptoms using exploratory factor analysis.

MATERIALS AND METHODS - As part of the Multi-Disciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network, participants (N = 424) completed questionnaires including the Genitourinary Pain Index (GUPI), the Interstitial Cystitis Symptom Index (ICSI), and the Interstitial Cystitis Problem Index (ICPI). Individual items from questionnaires about bladder and pain symptoms were evaluated by principal components and exploratory factor analysis to identify indices with fewer questions to comprehensively quantify symptom severity. Additional analyses included correlating symptom indices with symptoms of depression, a known comorbidity of patients with pelvic pain.

RESULTS AND CONCLUSIONS - Exploratory factor analyses suggested that two factors, pain severity and urinary severity, provided the best psychometric description of items contained in the GUPI, the ICSI, and the ICPI. These factors were used to create two symptom indices for pain and urinary symptoms. Pain, but not urinary symptoms, was associated with symptoms of depression in a multiple regression analysis, suggesting that these symptoms may impact patients with UCCPS differently; for pain severity, B (SE) = 0. 24 (0. 04), 95% CI of B = 0. 16-0. 32, β = 0. 32, p < . 001. Our results suggest that pain and urinary symptoms should be assessed separately, rather than combined into one total score. Total scores that combine the separate factors of pain and urinary symptoms into one score may be limited for clinical and research purposes.

The Journal of urology. 2015 Nov 13 [Epub ahead of print]

James W Griffith, Alisa J Stephens-Shields, Xiaoling Hou, Bruce Naliboff, Michel Pontari, Todd C Edwards, David A Williams, J Quentin Clemens, Niloofar Afari, Frank Tu, Robert Lloyd, Donald L Patrick, Chris Mullins, John W Kusek, Siobhan Sutcliffe, Barry A Hong, H Henry Lai, John N Krieger, Catherine S Bradley, Jayoung Kim, J Richard Landis

Northwestern University. , University of Pennsylvania. , University of Pennsylvania. , University of California Los Angeles. , Temple University. , University of Washington. , University of Michigan. , University of Michigan. , University of California, San Diego and the VA Center of Excellence for Stress and Mental Health. , NorthShore University HealthSystem and the University of Chicago. , Northwestern University. , University of Washington. , National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health. , National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health. , Washington University in St. Louis. , Washington University in St. Louis. , Washington University in St. Louis. , University of Washington. University of Iowa. , Cedars-Sinai Medical Center. , University of Pennsylvania.

PubMed

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