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Pain. 2019 Jun;160(6):1270-1280. doi: 10.1097/j.pain.0000000000001505.

Quantitative assessment of nonpelvic pressure pain sensitivity in urologic chronic pelvic pain syndrome: a MAPP Research Network study.

Author information

1
Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, United States.
2
Department of Mathematics, West Chester University, West Chester, PA, United States.
3
Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.
4
Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, United States.
5
Division of Urologic Surgery, Departments of Surgery and Anesthesiology, Washington University in St. Louis, St. Louis, MO, United States.
6
Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, MO, United States.
7
Departments of Medicine and Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, United States.
8
Department of Psychiatry, University of California San Diego, San Diego, CA, United States.
9
Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, San Diego, CA, United States.
10
Department of Obstetrics and Gynecology, Northshore University Health System, Evanston, IL, United States.

Abstract

Experimental pain sensitivity was assessed in individuals with urologic chronic pelvic pain syndrome (UCPPS) as part of the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network. A series of computer-controlled pressure stimuli were delivered to the thumbnail bed, an asymptomatic site distant from the area of UCPPS pain that is considered to be indicative of overall body pain threshold. Stimuli were rated according to a standardized magnitude estimation protocol. Pain sensitivity in participants with UCPPS was compared with healthy controls and a mixed pain group composed of individuals with other chronic overlapping pain conditions, including fibromyalgia, chronic fatigue, and irritable bowel syndromes. Data from 6 participating MAPP testing sites were pooled for analysis. Participants with UCPPS (n = 153) exhibited an intermediate pain sensitivity phenotype: they were less sensitive relative to the mixed pain group (n = 35) but significantly more sensitive than healthy controls (n = 100). Increased pain sensitivity in patients with UCPPS was associated with both higher levels of clinical pain severity and more painful body areas outside the pelvic region. Exploratory analyses in participants with UCPPS revealed that pain sensitivity increased during periods of urologic symptom flare and that less pressure pain sensitivity at baseline was associated with a greater likelihood of subsequent genitourinary pain improvement 1 year later. The finding that individuals with UCPPS demonstrate nonpelvic pain hypersensitivity that is related to clinical symptoms suggests that central nervous system mechanisms of pain amplification contribute to UCPPS.

PMID:
31050659
PMCID:
PMC6527452
[Available on 2020-06-01]
DOI:
10.1097/j.pain.0000000000001505

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