TY - JOUR
T1 - Clinical Phenotyping for Pain Mechanisms in Urologic Chronic Pelvic Pain Syndromes
T2 - A MAPP Research Network Study
AU - Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network
AU - Schrepf, Andrew
AU - Gallop, Robert
AU - Naliboff, Bruce
AU - Harte, Steven E.
AU - Afari, Niloofar
AU - Lai, H. Henry
AU - Pontari, Michel
AU - McKernan, Lindsey C.
AU - Strachan, Eric
AU - Kreder, Karl J.
AU - As-Sanie, Sawsan A.
AU - Rodriguez, Larissa V.
AU - Griffith, James W.
AU - Williams, David A.
N1 - Publisher Copyright:
© 2022
PY - 2022/9
Y1 - 2022/9
N2 - Three categories of pain mechanisms are recognized as contributing to pain perception: nociceptive, neuropathic, and nociplastic (ie, central nervous system augmented pain processing). We use validated questionnaires to identify pain mechanisms in Urologic Chronic Pelvic Pain Syndrome (UCCPS) patients (n = 568, female = 378, male = 190) taking part in the Symptom Patterns Study of the Multidisciplinary Approach to the study of chronic Pelvic Pain Research Network. A cutoff score of 12 on the painDETECT questionnaire (-1 to 38) was used to classify patients into the neuropathic category while the median score of 7 on the fibromyalgia survey criteria (0–31) was used to classify patients into the nociplastic category. Categories were compared on demographic, clinical, psychosocial, psychophysical and medication variables. At baseline, 43% of UCPPS patients were classified as nociceptive-only, 8% as neuropathic only, 27% as nociceptive+nociplastic, and 22% as neuropathic+nociplastic. Across outcomes nociceptive-only patients had the least severe symptoms and neuropathic+nociplastic patients the most severe. Neuropathic pain was associated with genital pain and/or sensitivity on pelvic exam, while nociplastic pain was associated with comorbid pain conditions, psychosocial difficulties, and increased pressure pain sensitivity outside the pelvis. A self-report method classifying individuals on pain mechanisms reveals clinical differences that could inform clinical trials and novel targets for treatment. Perspective: This article presents differences in clinical characteristics based on a simple self-report method of classifying pain mechanisms for Urologic Chronic Pelvic Pain Syndrome patients. This method can be easily applied to other chronic pain conditions and may be useful for exploring pathophysiology in pain subtypes.
AB - Three categories of pain mechanisms are recognized as contributing to pain perception: nociceptive, neuropathic, and nociplastic (ie, central nervous system augmented pain processing). We use validated questionnaires to identify pain mechanisms in Urologic Chronic Pelvic Pain Syndrome (UCCPS) patients (n = 568, female = 378, male = 190) taking part in the Symptom Patterns Study of the Multidisciplinary Approach to the study of chronic Pelvic Pain Research Network. A cutoff score of 12 on the painDETECT questionnaire (-1 to 38) was used to classify patients into the neuropathic category while the median score of 7 on the fibromyalgia survey criteria (0–31) was used to classify patients into the nociplastic category. Categories were compared on demographic, clinical, psychosocial, psychophysical and medication variables. At baseline, 43% of UCPPS patients were classified as nociceptive-only, 8% as neuropathic only, 27% as nociceptive+nociplastic, and 22% as neuropathic+nociplastic. Across outcomes nociceptive-only patients had the least severe symptoms and neuropathic+nociplastic patients the most severe. Neuropathic pain was associated with genital pain and/or sensitivity on pelvic exam, while nociplastic pain was associated with comorbid pain conditions, psychosocial difficulties, and increased pressure pain sensitivity outside the pelvis. A self-report method classifying individuals on pain mechanisms reveals clinical differences that could inform clinical trials and novel targets for treatment. Perspective: This article presents differences in clinical characteristics based on a simple self-report method of classifying pain mechanisms for Urologic Chronic Pelvic Pain Syndrome patients. This method can be easily applied to other chronic pain conditions and may be useful for exploring pathophysiology in pain subtypes.
KW - Nociceptive pain
KW - central nervous system sensitization
KW - chronic pain
KW - cystitis
KW - neuropathic pain
UR - http://www.scopus.com/inward/record.url?scp=85135180745&partnerID=8YFLogxK
U2 - 10.1016/j.jpain.2022.03.240
DO - 10.1016/j.jpain.2022.03.240
M3 - Article
C2 - 35472518
AN - SCOPUS:85135180745
SN - 1526-5900
VL - 23
SP - 1594
EP - 1603
JO - Journal of Pain
JF - Journal of Pain
IS - 9
ER -