George Warren Brown School, Washington University, St Louis, Missouri.
Division of Public Health Sciences, Washington University School of Medicine, St Louis, Missouri.
Neurourol Urodyn. 2019 Nov;38(8):2333-2350. doi: 10.1002/nau.24150. Epub 2019 Sep 4.
To investigate changes in whole body pain during urologic chronic pelvic pain syndrome (UCPPS) flares.
UCPPS participants at one site of the multidisciplinary approach to the study of chronic pelvic pain research network reported their daily flare status and pain levels in 7 pelvic/genital and 42 extrapelvic body areas (scale = 0-10) for 10 days at baseline and during their first flare. Linear mixed models and conditional logistic regression were used to investigate symptom changes during flares. Analyses were stratified by chronic overlapping pain condition (COPC) status.
Fifty-five out of 60 participants completed the study, 27 of whom provided information on both nonflare (n = 281) and flare (n = 208) days. Pelvic/genital pain intensity (mean change = 3.20 of 10) and widespreadness (mean = 1.48) increased significantly during flares for all participants (all P interaction > .1), whereas extrapelvic pain intensity increased significantly only among participants with COPCs (mean = 2.09; P interaction < .0001). Pelvic/genital and extrapelvic pain also varied on nonflare days but symptom fluctuations were generally ≤1 point (80.0%-100% of participants). Increases of ≥2 points in pelvic/genital pain intensity (odds ratio (OR) = 22.0, 95% confidence interval (CI) = 4.0-118.6) and ≥1 point in urination-related pain (OR = 9.10, 95% CI = 1.74-47.7) were independently associated with flare onset for all participants.
Our observations of extrapelvic pain increases during flares for patients with COPCs and our independent associations between pelvic/genital/urination-related pain intensity and flare onset may provide insight into mechanisms underlying flare development (eg, common biologic pathways between UCPPS phenotypes and flares), flare management (eg, local vs systemic therapies by COPC status), and patient flare definitions.
研究泌尿科慢性盆腔疼痛综合征 (UCPPS) 发作时全身疼痛的变化。
多学科慢性盆腔疼痛研究网络的一个研究点的 UCPPS 参与者报告了他们在基线和第一次发作期间的 10 天内每天的发作状态和 7 个盆腔/生殖器和 42 个盆腔外身体区域的疼痛水平（范围为 0-10）。线性混合模型和条件逻辑回归用于研究发作期间的症状变化。分析按慢性重叠疼痛状况 (COPC) 状态进行分层。
60 名参与者中有 55 名完成了研究，其中 27 名参与者提供了非发作（n=281）和发作（n=208）天的信息。所有参与者的盆腔/生殖器疼痛强度（平均变化为 10 的 3.20）和广泛性（平均 1.48）在发作期间显著增加（所有 P 交互作用>0.1），而 COPC 参与者的盆腔外疼痛强度仅显著增加（平均 2.09；P 交互作用<0.0001）。盆腔/生殖器和盆腔外疼痛在非发作日也有变化，但症状波动通常≤1 点（80.0%-100%的参与者）。盆腔/生殖器疼痛强度增加≥2 点（优势比 (OR) = 22.0，95%置信区间 (CI) = 4.0-118.6）和排尿相关疼痛增加≥1 点（OR = 9.10，95% CI = 1.74-47.7）与所有参与者的发作开始独立相关。
我们观察到 COPC 患者在发作期间盆腔外疼痛增加，以及我们在盆腔/生殖器/排尿相关疼痛强度与发作开始之间的独立关联，这可能为发作发展的机制（例如，UCPPS 表型和发作之间的共同生物学途径）、发作管理（例如，根据 COPC 状态进行局部或全身治疗）和患者发作定义提供见解。
