Multi-Disciplinary Approach to the Study of Chronic Pelvic Pain

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Research Projects

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Research Focus Areas

Often medical research investigates only what’s happening with a particular body organ or system. For example, traditional research approaches attempt to learn more about what’s wrong with the bladder in patients with IC/PBS. Likewise, the prostate is commonly the focus of the studies investigating the cause of CP/CPPS. The MAPP Network is novel in this regard in that it moves away from this organ-specific focus and employs a broader, systemic (i.e., whole body) approach for the study of these two urological chronic pelvic pain conditions.

The MAPP Network is currently studying IC/PBS and CP/CPPS, as well as their potential relationship with other pain-centered disorders, through a variety of complementary scientific approaches:

Epidemiology of Disease / Phenotyping

This area of research examines how and why patients develop disease and how their disease changes over time.  This area also looks at genetic, behavioral/lifestyle, environmental, and other factors as contributors to disease.

MAPP Network epidemiology studies will look at relevant participant groups over time and will involve the collaboration of all MAPP Network sites. The MAPP Network epidemiologists will identify who has IC/PBS and CP/CPPS and will answer questions on how disease develops and changes.

Based on commonalities—such as gender, symptoms, genetics, and environmental exposures—the MAPP Network epidemiologists will address a series of research questions. Of note is the goal to develop participant groupings that may represent specific categories of urologic chronic pelvic pain patients. This may serve to enhance attempts to target treatment to different participants based on their unique disease profiles.

MAPP Network epidemiologists are working collaboratively with network scientists focused on the characterization of urologic and non-urologic disease phenotypes. Studies focused on participant phenotypes look at what makes your body unique and considers genetic, behavioral, and biological differences. MAPP Network investigators involved in urological phenotyping are developing a “working definition” for urological chronic pelvic pain disorders to be used by MAPP Network scientists. They will also design the diagnostic path—or the series of tests and questions—used to determine if a participant has IC/PBS or CP/CPPS. These will be used for all MAPP Network studies. Network investigators addressing non-urological phenotypes of participants are interested in assessing characteristics of participants with conditions not specific to urological systems (e.g., the bladder and prostate). These investigators are establishing a questionnaire survey and other tests to assess participant characteristics across a number of pain conditions potentially found in association with IC/PBS and/or CP/CPPS, such as irritable bowel syndrome, fibromyalgia, and chronic fatigue syndrome. The survey tools will attempt to address unexplained medical and psychological conditions, as well as specific disease symptoms, and behavioral and environmental factors. Once completed, each Discovery Site will employ this standardized assessment tool when assessing overlapping conditions for all participants recruited into MAPP Network studies.

Collectively these investigators comprise the MAPP Network Epidemiology/Phenotyping Working Group. In addition to addressing disease changes over time and participant phenotypes, this group is developing research tools to standardize how participants across the MAPP Network are enrolled and characterized. This foundation serves to unify the numerous research projects being conducted in Discovery Sites by ensuring the various scientific approaches are looking at similar participant groups, which yields more reliable study findings.

Epidemiology/Phenotyping Working Group Chair:

Daniel J Clauw, MD
Professor of Anesthesiology & Medicine
Associate Dean for Clinical & Translational Research
Director, Chronic Pain & Fatigue Research Center
University of Michigan

Neuroimaging / Neurobiology

Tests that look at brain structure and function (e.g., neuroimaging studies) can help diagnosis and define certain pain conditions. Types of neuroimaging tests include computed tomography, magnetic resonance imaging (MRI), and positron-emission tomography. In pelvic pain conditions, functional MRIs may be used to confirm symptoms in patients suffering from painful conditions.

The Neuroimaging / Neurobiology working group is identifying the possible neurological (i.e., based in the nervous system) causes of the urologic chronic pelvic pain disorders.  The group is also working to understand how the neurology of patients may change based on disease symptoms and how patient neurology may differ if they suffer from additional, possibly related, disorders.

Focus Area Chair:

Emeran A Mayer, MD
Director, Center for Neurobiology of Stress
David Geffen School of Medicine at UCLA
University of California, Los Angeles

Biomarkers

Biomarkers are unique substances or features (e.g., proteins, genes, features of anatomy, etc.) found in people with specific conditions that serve to identify the presence of diseases. Identification of biomarkers can help us diagnose and predict disease and may lead to a better understanding of the underlying causes of disease. Also, biomarkers can help physicians and researchers sub-group patients for more targeted treatments or research studies.

The Biomarkers working group will identify biomarkers that help to describe the causes and symptoms of urologic pain syndromes and will assess how such biomarkers can change during disease and when additional, possibly related, disease conditions are present.

Focus Area Chair:

Marsha A. Moses, PhD
Julia Dyckman Andrus Professor, Harvard Medical School
Director, Vascular Biology Program, Children's Hospital Boston
Department of Surgery, Harvard Medical School & Children's Hospital Boston

Focus Area Co-Chair:

Michel A. Pontari, MD
Professor and Vice Chair
Department of Urology
Temple University School of Medicine

UCPPS Translational Animal Models

In some cases, patients with urologic pelvic pain syndromes may also suffer from additional or “co-morbid” conditions such as irritable bowel syndrome. The pelvic organs (bladder and urinary system, reproductive organs, and bowel) are assumed to contribute to these syndromes. Importantly, these organs share neural pathways (or “neural circuits”) in your body. The shared neural pathways and demonstrated co-occurrence of pelvic disorders in chronic pelvic pain syndromes suggest the possibility that “crosstalk” exists between pelvic organs, meaning that one pelvic organ influences another. Several research studies have demonstrated pelvic organ crosstalk. Animal studies reveal that stimulating a single spinal nerve can affect both the bladder and the bowel. Stimulating the bowel can also contribute to bladder inflammation and enhance bladder-associated pelvic pain. 

This working group will look at how the urologic chronic pelvic pain disorders might relate to other conditions through human studies, as well as studies in a number of animal models of disease.

Focus Area Chair:

H. Henry Lai, MD
Associate Professor of Surgery (Urology)
Associate Professor of Anesthesiology
Washington University School of Medicine, St Louis, Missouri

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