Widespread Pain Moderates the Response to Centrally-Acting Therapies in an Observational Cohort of Patients With Urologic Chronic Pelvic Pain Syndrome: A MAPP Research Network Study.

PURPOSE

Urologic Chronic Pelvic Pain Syndrome (UCPPS) impacts millions of people in the United States but treatment options remain largely unsatisfying. A large number of neurobiological studies from the Multidisciplinary Approach to the study of chronic Pelvic Pain (MAPP) research network and others point to aberrant pain mechanisms in patients with UCPPS and widespread pain, but the clinical significance of widespread pain has been speculative.

MATERIALS AND METHODS

In the current exploratory study we investigated whether pain and urologic symptoms responded to centrally-directed therapies (tricyclic antidepressants/gabapentinoids) versus peripherally-directed (pelvic floor physical therapy/hydrodistension) therapies depending on the presence or absence of widespread pain when the new treatment was initiated.

RESULTS AND CONCLUSIONS

Forty UCPPS patients (n = 19 widespread) underwent an evaluation of UCPPS symptoms before and after twelve weeks of either centrally-directed (n = 16) or peripherally-directed therapy. Participants were stratified post hoc into widespread (two or more non-pelvic pain sites + pelvic pain) and localized pain categories. General linear models were used to test the group X treatment interaction effect, adjusting for age, sex, and baseline outcome levels. On average, patients with widespread pain receiving centrally-directed therapies improved more than six points on the 0-28 Pelvic Pain Severity scale, while those with localized pain showed no average improvement (interaction p = 0.005). Similar effects were observed for the bladder symptom impact score (interaction p = 0.011) but not urologic symptom severity (interaction p = 0.72). While these findings are exploratory, they provide preliminary evidence for phenotype X treatment interactions in UCPPS and should be followed by confirmatory studies.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02514265-MAPP Research Network: Trans-MAPP Study of Urologic Chronic Pelvic Pain: Symptom Patterns Study (SPS).

CLINICALTRIALS

gov Identifier: NCT02898220-Trans-MAPP Study of Urologic Chronic Pelvic Pain: Control Study Protocol.xs.