A New Look at Urological Chronic Pelvic Pain ...
To help better understand the underlying causes of the two most prominent chronic urological pain disorders—interstitial cystitis/ bladder pain syndrome (IC/BPS) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), in 2008 the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH) established the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network.
The MAPP Research Network embraces a systemic—or whole-body—approach in the study of Urologic Chronic Pelvic Pain Syndrome (UCPPS). UCPPS is a term adopted by the network to encompass both IC/BPS and CP/CPPS, which are proposed as related based on their similar symptom profiles. In addition to moving beyond traditional bladder- and prostate-specific research directions, MAPP Network scientists are investigating potential relationships between UCPPS and other chronic conditions that are sometimes seen in IC/PBS and CP/CPPS patients, such as irritable bowel syndrome, fibromyalgia, and chronic fatigue syndrome.
The primary clinical research effort carried out during the MAPP Network’s the first 5-year project period (MAPP I) was a prospective cohort study, the Trans-MAPP Epidemiology/Phenotyping (EP) Study. From 12/14/2009 through 12/14/2012 1,039 men and women were enrolled, including persons with UCPPS (n=424); persons with other co-morbid illnesses, including fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome (n=200 for all conditions); and healthy controls (n=415). Allstudy participants were extensively characterized (i.e., phenotyped) at baseline, and UCPPS participants were further assessed during an additional 12 month follow-up period.
Initial analyses of these data have identified a number of provocative findings. There are strong indications those certain subgroups of participants (albeit with small sample sizes) with urinary and non-urinary symptoms tend to improve over time; whereas other subgroups tend to worsen over time. These patterns of improving or worsening are differentially expressed according to sex, subtype of bladder pain syndrome (BPS), and pain location (e.g., localized to the pelvic region vs pain reported in the pelvic region as well as other body sites).
The second phase of the MAPP Network is now underway and is designed to conduct a prospective, observational study of men and women with UCPPS, referred to as the Trans-MAPP Symptom Patterns Study (SPS). The this collaborative study will be enriched with pre-defined subgroups and involves a longer follow-up in order to describe UCPPS symptom changes over time and associated changes in underlying biology. The Trans-MAPP SPS will further investigate and extend upon clinical and biologic insights identified in MAPP I and will examine the potential for classification of UCPPS patients into clinically meaningful sub-groups based on differing pathophysiological profiles and/or potential to respond to certain clinical interventions.
The highly multidisciplinary (i.e., scientists employing a variety of research approaches) MAPP Network includes researchers with clinical, epidemiological, and basic research expertise, all working collaboratively:
- Clinical researchers bring experience treating patients
- Epidemiological investigators study the occurrence of, and identify risk factors for, IC/PBS and CP/CPPS
- Basic research scientists examine what’s happening on a cellular level
The MAPP Network includes multiple key focus areas, including:
- Epidemiology of Disease
- Phenotyping of Urological and Non-Urological symptoms
- Neuroimaging / Neurobiology Studies
- Quantitative Sensory Testing
- Identification of Biomarkers of Disease
- Potential influences of the microbiome
- Studies of relevant UCPPS animal models
The MAPP Research Network is comprised of six Discovery Sites that recruit participants and conduct the research studies and two Core Sites that coordinate data collection, analyze tissue samples, and provide technical support. In addition, the network supports three non-recruiting Discovery Sites that are focused in specific research areas of interest. To further broaden the scope and investigator base beyond the Discovery and Core sites, the MAPP Network also fosters the incorporation of ancillary study sites tasked with the conduct of clinical, basic, and translational research performed in collaboration within the network.
By promoting novel and innovative research approaches, the MAPP Network aims to discover new and clinically relevant insights that may lead to improved treatment options and better patient care.
How Can You Participate?
There are currently opportunities for interested participants to get involved with this important research. Your interest and willingness to enroll in the research studies now being initiated by the MAPP Research Network is vitally important to achieving the goals for improved treatment options and better patient care. Please follow this participant link for updates and for information on how you can get involved. (Learn more)