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JU INSIGHT Urological Chronic Pelvic Pain Syndrome Symptom Flares, Illness Impact, and Health Care Seeking
By: Siobhan Sutcliffe, PhD, ScM, MHS, Washington University School of Medicine, St Louis, Missouri; Craig Newcomb, MS, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catherine S. Bradley, MD, MSCE, Carver College of Medicine, University of Iowa, Iowa City; J. Quentin Clemens, MD, University of Michigan, Ann Arbor; Bradley Erickson, MD, MS, Carver College of Medicine, University of Iowa, Iowa City; Priyanka Gupta, MD, University of Michigan, Ann Arbor; H. Henry Lai, MD, Washington University School of Medicine, St Louis, Missouri; Bruce Naliboff, PhD, Geffen School of Medicine, University of California Los Angeles; Eric Strachan, PhD, MA, University of Washington School of Medicine, Seattle; Alisa Stephens-Shields, PhD, AM, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia | Posted on: 20 Apr 2023
Sutcliffe S, Newcomb C, Bradley CS et al, for the MAPP Research Network. Associations between urological chronic pelvic pain syndrome symptom flares, illness impact, and health care seeking activity: findings from the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Symptom Patterns study. J Urol. 2023;209(4):719-725.
Study Need and Importance
Urological chronic pelvic pain syndrome (UCPPS) symptom exacerbations or “flares” are often painful and debilitating, yet little is known about how to prevent and/or treat them. One possible reason for this dearth of information is the paucity of studies that have included flares as their outcome. Instead, most studies use patient-reported “typical” or “average” levels of pelvic pain as their outcome. These could potentially be sufficient to study flares if typical pain levels tend to capture pain intensity during flares or if the impact of flares is explained by the co-occurrence of worse nonflare pain levels and greater flare frequency (ie, confounding by typical pain levels; see Figure, model 1). However, no studies, to our knowledge, have investigated the effect of flares on illness impact independent of typical pain levels (see Figure, models 2-3) to inform the value of including flares as an additional outcome in UCPPS research.
What We Found
In the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Network Symptom Patterns Study (N=613 ), we found that participants who experienced ≥2 flares/wk had significantly worse condition-specific illness impact and greater health care seeking activity than those without flares, even after comparing participants with similar typical nonflare and overall pelvic pain levels. We also found that participants who experienced ≥1 flare/d had significantly worse general illness impact or disability.
Limitations
Our analysis was limited to flare frequency, but additional flare characteristics, such as duration, pain intensity, and predictability, may be worth considering in future studies.
Interpretation for Patient Care
Our findings suggest that patients may derive benefit from preventive and therapeutic strategies that reduce flare frequency even if they do not reduce “typical” pelvic pain levels. Therefore, we recommend including flare frequency as an additional outcome measure in UCPPS research to support the development of new flare strategies.
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