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. 2019 Sep;124(3):522-531.
doi: 10.1111/bju.14783. Epub 2019 May 29.

A longitudinal analysis of urological chronic pelvic pain syndrome flares in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network

Siobhan Sutcliffe  1 , Robert Gallop  2 , Hing Hung Henry Lai  3   4 , Gerald L Andriole  3 , Catherine S Bradley  5   6   7 , Gisela Chelimsky  8 , Thomas Chelimsky  9 , James Quentin Clemens  10 , Graham A Colditz  1 , Bradley Erickson  7 , James W Griffith  11 , Jayoung Kim  12 , John N Krieger  13 , Jennifer Labus  14 , Bruce D Naliboff  14 , Larissa V Rodriguez  15 , Suzette E Sutherland  13 , Bayley J Taple  11 , John Richard Landis  2
Affiliations

A longitudinal analysis of urological chronic pelvic pain syndrome flares in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network

Siobhan Sutcliffe et al. BJU Int. 2019 Sep.

Abstract

Objective: To describe the frequency, intensity and duration of urological chronic pelvic pain syndrome symptom exacerbations ('flares'), as well as risk factors for these features, in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Epidemiology and Phenotyping longitudinal study.

Participants and methods: Current flare status ('urological or pelvic pain symptoms that are much worse than usual') was ascertained at each bi-weekly assessment. Flare characteristics, including start date, and current intensity of pelvic pain, urgency and frequency (scales of 0-10), were assessed for participants' first three flares and at three randomly selected times when they did not report a flare. Generalized linear and mixed effects models were used to investigate flare risk factors.

Results: Of the 385 eligible participants, 24.2% reported no flares, 22.9% reported one flare, 28.3% reported 2-3 flares, and 24.6% reported ≥4 flares, up to a maximum of 18 during the 11-month follow-up (median incidence rate = 0.13/bi-weekly assessment, range = 0.00-1.00). Pelvic pain (mean = 2.63-point increase) and urological symptoms (mean = 1.72) were both significantly worse during most flares (60.6%), with considerable within-participant variability (26.2-37.8%). Flare duration varied from 1 to 150 days (94.3% within-participant variability). In adjusted analyses, flares were more common, symptomatic, and/or longer-lasting in women and in those with worse non-flare symptoms, bladder hypersensitivity, and chronic overlapping pain conditions.

Conclusion: In this foundational flare study, we found that pelvic pain and urological symptom flares were common, but variable in frequency and manifestation. We also identified subgroups of participants with more frequent, symptomatic, and/or longer-lasting flares for targeted flare management/prevention and further study.

Keywords: epidemiology; interstitial cystitis; prostatitis; symptom flare-up.

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Figures

Appendix Figure 1.
Appendix Figure 1.. Frequency of urologic chronic pelvic pain syndrome flares in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Epidemiology and Phenotyping Study, 2009–2013.
On each bi-weekly assessment of the MAPP study, participants were asked to report whether they were currently experiencing a flare of their urologic or pelvic pain symptoms (i.e., “symptoms that are much worse than usual”). The percentage of participants who reported each number of flares over the last 11 months of the one-year study is plotted.
Figure 1.
Figure 1.. Flare and non-flare symptoms in urologic chronic pelvic pain syndrome participants in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Epidemiology and Phenotyping Study, 2009–2013.
On each bi-weekly assessment of the one-year MAPP study follow-up, participants were asked to report whether they were currently experience a flare of their urologic or pelvic pain symptoms (i.e., “symptoms that are much worse than usual”). If participants responded affirmatively, they were directed to a second questionnaire on which they were asked about their current intensity of pelvic pain, urinary urgency, and frequency on scales of 0-10. This questionnaire was completed for the first three reported flares. Participants were also asked to complete the second questionnaire at three randomly-selected times when they did not report a flare. Figure A describes the distribution of pelvic pain intensity reported at non-flare (light pink) and flare (blue) assessments. Overlapping values are indicated in dark pink. Figure B describes the distribution of urologic symptom intensity (i.e., the maximum of urgency and frequency intensity) at non-flare (light pink) and flare (blue) assessments. Changes in pelvic pain and urologic symptom intensity during flares are described in Figures C and D, using the closest non-flare and flare assessments for comparison. Figure E presents the joint distribution of changes in pelvic pain and urologic symptom intensity during flares.
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References

    1. Sutcliffe S, Colditz GA, Goodman MS, Pakpahan R, Vetter J, Ness TJ, et al. Urological chronic pelvic pain syndrome symptom flares: characterisation of the full range of flares at two sites in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network. BJU international. 2014; 114(6):916–25. doi: 10.1111/bju.12778. - DOI - PMC - PubMed
    1. Clemens JQ, Calhoun EA, Litwin MS, McNaughton-Collins M, Kusek JW, Crowley EM, et al. Validation of a modified National Institutes of Health chronic prostatitis symptom index to assess genitourinary pain in both men and women. Urology. 2009; 74(5):983–7 quiz 7 e1-3. doi: 10.1016/j.urology.2009.06.078. - DOI - PMC - PubMed
    1. Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore. 1994; 23(2):129–38. Epub 1994/03/01. - PubMed
    1. Berry SH, Elliott MN, Suttorp M, Bogart LM, Stoto MA, Eggers P, et al. Prevalence of symptoms of bladder pain syndrome/interstitial cystitis among adult females in the United States. J Urol. 2011; 186(2):540–4. doi: 10.1016/j.juro.2011.03.132. - DOI - PMC - PubMed
    1. Lai HH, Krieger JN, Pontari MA, Buchwald D, Hou X, Landis JR, et al. Painful Bladder Filling and Painful Urgency are Distinct Characteristics in Men and Women with Urological Chronic Pelvic Pain Syndromes: A MAPP Research Network Study. J Urol. 2015. 194(6):1634–41. doi: 10.1016/j.juro.2015.05.105. - DOI - PMC - PubMed

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