Changes in whole body pain intensity and widespreadness during urologic chronic pelvic pain syndrome flares—Findings from one site of the MAPP study

Tianlin Xu, H. Henry Lai, Ratna Pakpahan, Joel Vetter, Gerald L. Andriole, Catherine Bradley, Bruce D. Naliboff, Graham A. Colditz, Siobhan Sutcliffe

Research output: Contribution to journalArticlepeer-review


Objective: To investigate changes in whole body pain during urologic chronic pelvic pain syndrome (UCPPS) flares. Materials and Methods: 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. Results: 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)2333-2350
Number of pages18
JournalNeurourology and Urodynamics
Issue number8
StatePublished - Nov 1 2019
Externally publishedYes


  • chronic prostatitis
  • flares
  • interstitial cystitis
  • longitudinal study
  • symptom exacerbations

ASJC Scopus subject areas

  • Clinical Neurology
  • Urology


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