High-impact Chronic Pain in a Cohort of Urologic Chronic Pelvic Pain Syndrome Patients: A Retrospective MAPP Research Network Study

Objectives:An emerging concept in the chronic pain literature, high-impact chronic pain (HICP), refers to pain that occurs very frequently and results in major disruption of daily life. Previous epidemiologic investigations have noted that lower educational attainment, age, and race appear to be associated with the frequency of HICP, but condition-specific investigations of HICP have been less common. Materials and Methods:Here we investigate HICP status and its clinical/demographic correlates in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network symptom pattern study. Results:Participants were 476 urologic pelvic pain syndrome (UCPPS) patients, 64% of whom were female. Of these, 22% were classified as having HICP based on responses to several questions about pain interference in daily life. We confirmed that African American individuals and those with lower educational attainment were more likely to experience HICP (both P<0.05). In addition, those with HICP demonstrated much greater levels of disability, genitourinary pain, urinary symptoms, widespread pain, and pelvic floor tenderness and were more likely to experience pain in response to consuming standardized amounts of water (all P<0.05). Binary logistics regression showed that genitourinary pain, widespread pain, and race were the strongest predictors of pain in multivariate models. Furthermore, HICP status was associated with more self-reported health care utilization over the subsequent 18 months (P<0.05). Discussion:These findings suggest that HICP affects more than 1 of 5 UCPPS patients, with significant associated morbidity. Demographic and clinical characteristics associated with HICP may be useful for identifying at-risk UCPPS patients.