Multi-Disciplinary Approach to the Study of Chronic Pelvic Pain

A

About MAPP

MAPP Network Logo
Image of bench scientists

About The MAPP Network

The Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network is conducting collaborative research on urological chronic pelvic pain disorders—specifically, interstitial cystitis/painful bladder syndrome (IC/PBS) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).

The MAPP study design looks beyond simply the bladder and prostate for the causes of disease. This national research network includes six Discovery Sites that will conduct multidisciplinary research studies, a Data Coordinating Core (DCC) that will coordinate data collection and analysis, and a Tissue Analysis and Technology Core (TATC) that will coordinate and analyze tissue samples and provide technical support.

The MAPP Research Network Discovery Sites include:

  • Northwestern University, Chicago, IL
  • University of California at Los Angeles, Los Angeles, CA
  • University of Iowa, Iowa City, IA
  • University of Michigan, Ann Arbor, MI
  • University of Washington, Seattle, WA
  • Washington University, St. Louis, MO

Additional network projects are located at:

  • Stanford University, Stanford, CA
  • CA and Children's Hospital Boston/Harvard Medical School, Boston, MA
  • Queen's University, Kingston, Ontario, Canada

The MAPP Research Network Core Sites include:

  • Data Coordinating Core (DCC): University of Pennsylvania, Philadelphia, PA
  • Tissue Analysis and Technology Core (TATC): University of Colorado in Denver, Denver, CO

The MAPP research effort is unique in that it conducts highly collaborative and multidisciplinary studies from a broadened systemic perspective, including the possible associations between IC/PBS and CP/CPPS and other pain-based disorders. This is a major shift from the traditional organ-specific focus of previous studies..

The MAPP Network also involves a wide breadth of researchers from varied disciplines, including some not previously involved in the study of urologic chronic pain syndromes. The Network also employs varied and complementary approaches.

MAPP Research Network Chair

Quentin Clemens, MD, MSCI
Professor of urology
Director, Division of Neurology & Pelvic Reconstructive Surgery
University of Michigan

MAPP Research Network Co-Chair for IC/PBS Research

Robert Moldwin, MD
Professor, Urology
Hofstra North Shore - LIJ School of Medicine
Director, Pelvic Pain Treatment Center
The Arthur Smith Institute for Urology
North Shore - LIJ Healthcare System

MAPP Research Networ Co-Chair for CP/CPPS Research

Michel Pontari, MD
DCC Clinical Collaborator
Department of Urology
Temple Univeristy School of Medicine

NIDDK Project Officers:

Chris Mullins, PhD
Director, Basic Cell Biology Programs in Urologic Kidney Disease
National Institute of Diabetes & Digestive & Kidney Diseases
National Institutes of Health

John W Kusek, PhD
Director, Kidney & Urological Clinical Trials
National Institute of Diabetes & Digestive & Kidney Diseases
National Institutes of Health

Background

Interstitial cystitis/painful bladder syndrome (IC/PBS) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) are syndromes predominantly defined by chronic pain in the region of the pelvis or urogenital floor. Lower urinary tract symptoms (LUTS), such as urinary urgency or frequency often occur in IC/PBS and CP/CPPS patients.

The bladder has been suggested as the origin of IC/PBS symptoms and the prostate gland traditionally believed to be the source of CP/CPPS symptoms. However, no organ-specific disease has been conclusively identified for either syndrome.

Diagnosis of IC/PBS and CP/CPPS is based solely on patient symptoms, due to the lack of identifiable pathological findings or physical disease characteristics and, indeed, each syndrome may represent a group of related conditions with differing underlying causes. Based on their similar symptom profile IC/PBS and CP/CPPS are here collectively termed urological chronic pelvic pain syndromes (UCPPS).

The impact and burden of UCPPS to patients is enormous. UCPPS patients suffer considerable morbidity throughout their lives resulting in a significant decrease in quality of life for both the patient and his/her partner due to the physical and physiological impact.

Despite many past research and clinical treatment efforts much remains to be learned regarding the:

  • Underlying syndrome etiology (i.e., the fundamental causes of a syndrome).
  • Natural history of UCPPS (i.e., how a syndrome develops and changes over time) and the importance of the patient’s genetics and biological, environmental, and lifestyle risk factors to syndrome development and progression.
  • Potential association of UCPPS with other chronic pain conditions affecting urological and non-urological systems.

Past research studies have had a traditional focus on the bladder and the prostate as the origins of disease for UCPPS. However, recent epidemiological studies have shown that other conditions that share chronic pain as a major symptom are often associated with UCPPS, including fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome. These findings suggest the possibility of a common underlying pathophysiology for chronic pain syndromes. However, these intriguing associations and their implications to syndrome development have not been adequately addressed in studies of UCPPS.

In addition, many previous urological-focused research efforts addressing UCPPS have not emphasized novel and innovative approaches or incorporated expertise from related fields of investigation. Also, basic, translational, and clinical researchers have had insufficient formal opportunities for collaboration in addressing common goals.

It has become apparent that the traditional concepts and strategies driving UCPPS research are in need of significant redirection.  Such a new strategy would require the introduction of new and novel methodologies and the involvement of related disciplines, in order to address the many long standing deficiencies in our understanding of these syndromes.

In light of these deficits and to address longstanding, key questions, the NIDDK proposes that the urologic centered focus of UCPPS (i.e., IC/PBS and CP/CPPS) research be broadened to a systemic view of syndromes in which the interplay between the urologic systems and other physiological systems is stressed. The NIDDK is emphasizing that studies of UCPPS be expanded to include new and novel methodologies and approaches involving a diversity of urologic and non-urologic clinical, translational, and basic science disciplines.

To promote these ideas, the NIDDK has developed and initiated the Multi-disciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network.

We anticipate this effort will lead to critical new insights into the underlying basis and risk for UCPPS, as well as the potential associations of UCPPS with co-morbid (i.e., conditions that are found in association with other disorders and can enhance disease symptoms) disorders. These insights have the potential for translation into future prevention and treatment strategies for patients. The MAPP Research Network is also working to develop new and more comprehensive research definitions/criteria for UCPPS that will adopt the idea of systemic syndromes. It is anticipated that these new definitions/criteria will enable MAPP Network researchers and the research community at large to identify more specific and relevant patient profiles for IC/PBS and CP/CPPS.

Goals & Objectives

The goals of the MAPP Research Network are to advance our understanding of:

  • Syndrome phenotypes (i.e., characteristics attributed to a syndrome).
  • Syndrome etiology (i.e., fundamental underlying causes of a syndrome).
  • Natural history (i.e., how a syndrome develops and changes over time), including biologic, genetic, and behavioral risk factors associated with a syndrome.

Another important objective of this program is to better understand the biologic and behavioral relationships between UCPPS and potentially-related chronic pain syndromes. Related chronic pain syndromes of primary interest are:

  • Fibromyalgia
  • Irritable bowel syndrome
  • Chronic fatigue syndrome. 

The MAPP Network will undertake multidisciplinary, multisite, and highly interactive basic, translational, and clinical science research studies.  These studies will use new and novel approaches to investigate questions of significant clinical relevance. All efforts are expected to provide findings useful for designing future clinical studies of syndrome prevention and/or treatment. The study of UCPPS as systemic syndromes (i.e., expanding the study of these disorders beyond the lower urinary tract) and the use of human study materials (e.g., biological specimens) will also be important objectives of the program.

 

 

 

About Us | ©2008 - 2017 Perelman School of Medicine at the University of Pennsylvania