Clinical and Psychosocial Predictors of Urologic Chronic Pelvic Pain Symptom Change Over One Year: A Prospective Study from the MAPP Research Network

To examine baseline clinical and psychosocial characteristics that predict 12- month symptom change in men and women with urologic chronic pelvic pain syndromes (UCPPS).

221 female and 176 male UCPPS patients were recruited from 6 academic medical centers in the United States and evaluated at baseline with a comprehensive battery of symptom, psychosocial, and illness-impact measures. Based on biweekly symptom reports, a functional clustering procedure classified participant's outcome as worse, stable, or improved on pain and urinary symptom severity. Cumulative logistic modeling was used to examine individual predictors associated with symptom change as well as multiple predictor combinations and interactions.

About 60% of participants had stable symptoms with smaller numbers (13% to 22%) showing clear symptom worsening or improvement. For both pain and urinary outcomes the extent of widespread pain, amount of non-urological symptoms and poorer overall health were predictive of worsening outcomes. Anxiety, depression and general mental health were not significant predictors of outcomes, but pain catastrophizing and self-reported stress were associated with pain outcome. Prediction models did not differ between men and women and for the most part were independent of symptom duration and age.

These results demonstrate for the first time in a large multisite prospective study that presence of widespread pain, non-urological symptoms and poorer general health are risk factors for poorer pain and urinary outcomes in both men and women. The results point to the importance of broad based assessment in UCPPS and future studies of mechanisms that underlie these findings.

The Journal of urology. 2017 May 18 [Epub ahead of print]

Bruce D Naliboff, Alisa J Stephens, H Henry Lai, James W Griffith, J Quentin Clemens, Susan Lutgendorf, Larissa V Rodriguez, Craig Newcomb, Siobhan Sutcliffe, Wensheng Guo, John W Kusek, J Richard Landis, MAPP Research Network

Departments of Medicine and Psychiatry and Biobehavioral Sciences, University of California, Los Angeles CA. Electronic address: ., Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA., Division of Urologic Surgery, Department of Surgery, and Department of Anesthesiology, Washington University School of Medicine, St Louis, MO., Department of Medical Social Sciences, Northwestern University, Evanston, IL., Department of Urology, University of Michigan School of Medicine, Ann Arbor, MI., Department of Psychological and Brain Sciences and Urology, University of Iowa, Iowa City, IA., Departments of Urology and Obstetrics and Gynecology, University of Southern California, Los Angeles, CA., Division of Public Health Sciences and the Alvin J. Siteman Cancer Center, Department of Surgery, Washington University School of Medicine, St. Louis, MO., National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.