Clinical and Psychosocial Predictors of Urological Chronic Pelvic Pain Symptom Change in 1 Year: A Prospective Study from the MAPP Research Network

Abstract

Purpose: We examined baseline clinical and psychosocial characteristics that predict 12-month symptom change in men and women with urological chronic pelvic pain syndromes.

Materials and methods: A total of 221 female and 176 male patients with urological chronic pelvic pain syndromes 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 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.

Results: About 60% of participants had stable symptoms with smaller numbers (13% to 22%) showing clear symptom worsening or improvement. For pain and urinary outcomes the extent of widespread pain, amount of nonurological 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 they were independent of symptom duration and age.

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

Keywords: cystitis; interstitial; pelvic pain; prostate; prostatitis; urinary bladder.

Figure 1

Functional clustering of participants based on biweekly symptom ratings (in grey), classified into one of three clusters (Improved, Stable, or Worse). Clustering was done separately for pain severity (top) and urinary severity (bottom). Red lines show the mean symptom ratings for each cluster. For details of the clustering methods see Supplemental Appendix C.

Figure 2

Predicted percent of participants Improved, Stable, and Worse stratified by baseline severity. For illustration purposes baseline severity is divided into quartiles. Pain severity outcome results are shown in the left panel and urinary severity in the right panel.

Figure 3

Predicted percent of participants Improved vs Worse on pain severity (Figure 3a) and urinary severity (Figure 3b) outcomes, based on selected baseline variables. For illustration purposes the Stable category subjects are not plotted. To simplify the presentation, predicted percentages are shown at the 25^th and 75^th percentile for each predictor. An * indicates a significant (p<.01) estimate for the variable in the full analysis.

Figure 4

Predicted percent of participants Improved vs Worse on pain severity (top) and urinary severity (bottom). Percentages are stratified on outcomes based on the interaction of SF-12 PCS with symptom duration and number of Body Map sites. To simplify the presentation predicted percentages are shown at the 25^th and 75^th percentile for SF-12 PCS and Body Map variables. An * indicates a significant (p<.01) interaction in the full analysis.

Figure 4

Predicted percent of participants Improved vs Worse on pain severity (top) and urinary severity (bottom). Percentages are stratified on outcomes based on the interaction of SF-12 PCS with symptom duration and number of Body Map sites. To simplify the presentation predicted percentages are shown at the 25^th and 75^th percentile for SF-12 PCS and Body Map variables. An * indicates a significant (p<.01) interaction in the full analysis.