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Pain. 2018 Oct;159(10):2002-2011. doi: 10.1097/j.pain.0000000000001299.

Sensory sensitivity and symptom severity represent unique dimensions of chronic pain: a MAPP Research Network study.

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Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, United States.
Department of Mathematics, West Chester University, West Chester, PA, United States.
Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.
Departments of Medicine and.
Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, United States.
School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland.
Department of Urology, University of Michigan, Ann Arbor, MI, United States.
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.
Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.
Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, United States.
Department of Psychiatry, University of California San Diego, San Diego, CA, United States.
Department of Urology, Temple University, Philadelphia, PA, United States.


Chronic overlapping pain conditions (COPCs) are characterized by aberrant central nervous system processing of pain. This "centralized pain" phenotype has been described using a large and diverse set of symptom domains, including the spatial distribution of pain, pain intensity, fatigue, mood imbalances, cognitive dysfunction, altered somatic sensations, and hypersensitivity to external stimuli. Here, we used 3 cohorts, including patients with urologic chronic pelvic pain syndrome, a mixed pain cohort with other COPCs, and healthy individuals (total n = 1039) from the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network to explore the factor structure of symptoms of centralized pain. Using exploratory and confirmatory factor analysis, we identified 2 general factors in all 3 cohorts, one characterized by a broad increased sensitivity to internal somatic sensations,environmental stimuli, and diffuse pain, termed Generalized Sensory Sensitivity, and one characterized by constitutional symptoms-Sleep, Pain, Affect, Cognition, Energy (SPACE). Longitudinal analyses in the urologic chronic pelvic pain syndrome cohort found the same 2-factor structure at month 6 and 1 year, suggesting that the 2-factor structure is reproducible over time. In secondary analyses, we found that Generalized Sensory Sensitivity particularly is associated with the presence of comorbid COPCs, whereas SPACE shows modest associations with measures of disability and urinary symptoms. These factors may represent an important and distinct continuum of symptoms that are indicative of the centralized pain phenotype at high levels. Future research of COPCs should accommodate the measurement of each factor.

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