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A MAPP Network Case-control Study of Urological Chronic Pelvic Pain Compared With Nonurological Pain Conditions

Afari, Niloofar PhD*; Buchwald, Dedra MD; Clauw, Daniel MD; Hong, Barry PhD§; Hou, Xiaoling MS; Krieger, John N. MD; Mullins, Chris PhD#; Stephens-Shields, Alisa J. PhD; Gasperi, Marianna PhD*; Williams, David A. PhD the MAPP Research Network

The Clinical Journal of Pain: January 2020 - Volume 36 - Issue 1 - p 8–15
doi: 10.1097/AJP.0000000000000769
Original Articles
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Objectives: Limited research suggests commonalities between urological chronic pelvic pain syndromes (UCPPS) and other nonurological chronic overlapping pain conditions (COPCs) including fibromyalgia, chronic fatigue syndrome, and irritable bowel syndrome. The goal of this case-control study was to examine similarities and differences between UCPPS and these other COPCs.

Materials and Methods: As part of the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research (MAPP) Network, we examined 1039 individuals with UCPPS (n=424), nonurological COPCs (n=200), and healthy controls (HCs; n=415). Validated standardized measures were used to assess urological symptoms, nonurological pain symptoms, and psychosocial symptoms and traits.

Results: Participants with UCPPS had more urological symptoms than nonurological COPCs or HCs (P<0.001); nonurological COPC group also had significantly worse urological symptoms than HCs (P<0.001). Participants with nonurological COPCs reported more widespread pain than those with UCPPS (P<0.001), yet both groups had similarly increased symptoms of anxiety, depression, negative affect, perceived stress, neuroticism, and lower levels of extraversion than HCs (P<0.001). Participants with UCPPS with and without COPCs reported more catastrophizing than those with nonurological COPCs (P<0.001).

Discussion: Findings are consistent with the hypothesis of common underlying biopsychosocial mechanisms and can guide the comprehensive assessment and treatment of these conditions regardless of the primary site of pain or diagnosis. Heightened catastrophizing in UCPPS should be examined to inform psychosocial interventions and improve patient care.

*VA Center of Excellence for Stress & Mental Health and Department of Psychiatry, University of California, San Diego, CA

Elson S. Floyd College of Medicine, Washington State University, Spokane, WA

Department of Urology, University of Washington, Seattle, WA

Departments of Anesthesiology, Medicine, and Psychiatry, University of Michigan, Ann Arbor, MI

§Department of Psychiatry, Washington University School of Medicine, St. Louis, MO

Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Philadelphia, PA

#National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD

Supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Multidisciplinary Approach to Chronic Pelvic Pain (MAPP) Research Network grants DK82370, Los Angeles, CA, DK82342, Chicago, IL, DK82315, St. Louis, MO, DK82344, Iowa City, IA, DK82325, Seattle, WA, DK82345, Ann Arbor, MI, DK82333, Aurora, CO, and DK82316, Philadelphia, PA.

The authors declare no conflict of interest.

Reprints: Niloofar Afari, PhD, 9500 Gilman Drive, 0737, La Jolla, CA 92093 (e-mail: nafari@ucsd.edu).

Received March 31, 2019

Received in revised form September 8, 2019

Accepted September 11, 2019

Online date: October 9, 2019

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