Relationship between chronic nonurological associated somatic syndromes and symptom severity in urological chronic pelvic pain syndromes: baseline evaluation of the MAPP study

Abstract

Purpose: We used MAPP data to identify participants with urological chronic pelvic pain syndromes only or a chronic functional nonurological associated somatic syndrome in addition to urological chronic pelvic pain syndromes. We characterized these 2 subgroups and explored them using 3 criteria, including 1) MAPP eligibility criteria, 2) self-reported medical history or 3) RICE criteria.

Materials and methods: Self-reported cross-sectional data were collected on men and women with urological chronic pelvic pain syndromes, including predominant symptoms, symptom duration and severity, nonurological associated somatic syndrome symptoms and psychosocial factors.

Results: Of 424 participants with urological chronic pelvic pain syndromes 162 (38%) had a nonurological associated somatic syndrome, including irritable bowel syndrome in 93 (22%), fibromyalgia in 15 (4%), chronic fatigue syndrome in 13 (3%) and multiple syndromes in 41 (10%). Of 233 females 103 (44%) had a nonurological associated somatic syndrome compared to 59 of 191 males (31%) (p = 0.006). Participants with a nonurological associated somatic syndrome had more severe urological symptoms and more frequent depression and anxiety. Of 424 participants 228 (54%) met RICE criteria. Of 228 RICE positive participants 108 (47%) had a nonurological associated somatic syndrome compared to 54 of 203 RICE negative patients (28%) with a nonurological associated somatic syndrome (p < 0.001).

Conclusions: Nonurological associated somatic syndromes represent important clinical characteristics of urological chronic pelvic pain syndromes. Participants with a nonurological associated somatic syndrome have more severe symptoms, longer duration and higher rates of depression and anxiety. RICE positive patients are more likely to have a nonurological associated somatic syndrome and more severe symptoms. Because nonurological associated somatic syndromes are more common in women, future studies must account for this potential confounding factor in urological chronic pelvic pain syndromes.

Keywords: cystitis; female; interstitial; male; questionnaires; urinary bladder.

Figure 1. Pain and Urological Symptoms in MAPP Participants with Chronic Urological Pain Syndromes With and Without Non-urological Associated Syndromes

Whiskers denote the 99% Confidence Interval of the adjusted mean difference of symptom level in standard deviation units *Denote statistical significance at the 0.01 level. **Denotes significance at the 0.001 level. SYM-Q: Symptom and Health Care Utilization Questionnaire; GUPI: Genitourinary Pain Index; AUA Symptom Index: American Urological Association Symptom Score Index; IC: Interstitial Cystitis; BPI: Brief Pain Inventory; IIEF – International Index of Erectile Function; FSFI: Female Sexual Function Index.

Figure 2. Psychosocial Factors in MAPP Participants with Chronic Urological Pain Syndromes With and Without Non-urological Associated Syndromes

Whiskers denote the 99% Confidence Interval of the adjusted mean difference of symptom level in standard deviation units *Denote statistical significance at the 0.01 level. **Denotes significance at the 0.001 level. HADS: Hospital Anxiety and Depression Scale; CSQ: Thoughts About Symptoms Questionnaire; PANAS: Positive and Negative Affect Schedule; IPIP: International Personality Item Pool.

Figure 3. Pain and Urological Symptoms in RICE-positive vs. RICE-negative MAPP Participants

Whiskers denote the 99% Confidence Interval of the adjusted mean difference of symptom level in standard deviation units *Denote statistical significance at the 0.01 level. **Denotes significance at the 0.001 level. SYM-Q: Symptom and Health Care Utilization Questionnaire; GUPI: Genitourinary Pain Index; AUA Symptom Index: American Urological Association Symptom Score Index; IC: Interstitial Cystitis; BPI: Brief Pain Inventory.