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Chronic pelvic pain syndrome patients prone to fibromyalgia, chronic fatigue

Men with longer symptom duration show worse severity for most symptom measures


San Diego—The likelihood of developing fibromyalgia and chronic fatigue syndrome increases over time in patients with urologic chronic pelvic pain syndromes (UCPPS), but only men seem to experience worsening of their urologic symptoms the longer the symptoms exist, according to analyses of the baseline characteristics of the Multidisciplinary Approach to Pelvic Pain (MAPP) study cohort.

Other results showed no association between urologic symptom duration and presence of irritable bowel syndrome. In addition, the research showed psychological symptoms and coping improved with longer UCPPS symptom duration in women, although these associations appeared to be accounted for by increasing age.

“The MAPP research network is a multidisciplinary collaborative project sponsored by the National Institute of Digestive and Kidney Diseases of the National Institutes of Health as an integrated approach to the study of UCPPS as a systemic disorder,” said first author Larissa V. Rodriguez, MD, professor of urology and gynecology and co-director of the division of pelvic medicine and reconstructive surgery at the David Geffen School of Medicine at UCLA. “Our aim is to address the underlying disease pathophysiology, natural history, and risks of interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome, and to provide a translational foundation to improve clinical trials and management of UCPPS.”

“These particular analyses were conducted to explore the hypothesis that longer UCPPS symptom duration is associated with more severe symptoms and a higher risk of nonurologic somatic syndromes,” added Dr. Rodriguez, who presented the findings at the AUA annual meeting in San Diego.

The analyses included data for 424 patients. The impact of symptom duration on the various patient characteristics was first analyzed looking at duration as a dichotomous variable (<2 years vs. ≥2 years). Information on urologic symptom severity was available from the Genitourinary Pain Index, the Interstitial Cystitis Symptom and Problem Index, AUA Symptom Score, and Likert scales for urinary pain, urgency, and frequency. A regression analysis was performed to adjust for patient age at onset of symptoms and at the time of study enrollment.

Symptom duration linked to severity in men

The authors found that men with longer symptom duration showed worse severity for nearly all symptom measures.

“We were concerned about the role of BPH and so we adjusted for age. However, it appears that the worsening of symptom severity with time in men is not entirely accounted for by increasing age,” Dr. Rodriguez said.

The impact of UCPPS symptom duration on psychological issues was investigated using data from the Hospital Anxiety and Depression Scale, the Perceived Stress Scale, and the Positive Affect-Negative Affect Scale. Among men, no differences were found in the scores for these instruments comparing those with a <2-year history of symptoms versus those with a longer duration.

Women with symptom duration ≥2 years showed less anxiety, depression, and stress as well as better ability to control pain with coping and more positive mood compared with their counterparts with a shorter history of disease. However, findings from an analysis adjusting for age indicated the improvements with longer symptom duration were accounted for by improved coping ability with age.

Dr. Rodriguez noted that the 2-year cutoff for investigating the impact of symptom duration was arbitrarily selected by an expert panel at the beginning of the study with the goal of differentiating patients who were earlier in their disease course from those whose disease might represent a more chronic condition. Because significant differences were not noted in many of the analyses separating patients by this dichotomous variable, analyses were also conducted with time as a continuous variable. The latter analyses suggested men developed more severe urologic symptoms and more negative psychological factors after 8 to 10 years’ disease duration, but no effects of time on these issues were observed in women.

In a multivariable analysis of the effect of time as a continuous variable, the likelihood of the UCPPS patients having chronic fatigue syndrome and fibromyalgia increased with each additional year of symptom duration.

The MAPP Network is comprised of six discovery sites that conduct the research studies and two core sites that coordinate data collection, analyze tissue samples, and provide technical support. Dr. Rodriguez’s co-investigators include J. Quentin Clemens, MD; Daniel J. Clauw, MD; Karl J. Kreder, MD, MBA; John N Krieger, MD; John W Kusek, PhD; H. Henry Lai, MD; David Williams, PhD; Xiaoling Hou, MS; Alisa Stephens, PhD; J. Richard Landis, MD, PhD; and the MAPP Research Network.UT


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