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Griffith JW, Stephens-Shields AJ, Hou X, Naliboff BD, Pontari M, Edwards TC, Williams DA, Clemens JQ, Afari N, Tu F, Lloyd RB, Patrick DL, Mullins C, Kusek JW, Sutcliffe S, Hong BA, Lai HH, Krieger JN, Bradley CS, Kim J, Landis JR. Pain and Urinary Symptoms Should Not be Combined into a Single Score: Psychometric Findings from the MAPP Research Network. J Urol 2015; 195:949-54. [PMID: 26585679 DOI: 10.1016/j.juro.2015.11.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2015] [Indexed: 12/30/2022]
Abstract
PURPOSE The purpose of this study was to create symptom indexes, that is scores derived from questionnaires to accurately and efficiently measure symptoms of interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome, collectively referred to as urological chronic pelvic pain syndromes. We created these indexes empirically by investigating the structure of symptoms using exploratory factor analysis. MATERIALS AND METHODS As part of the MAPP (Multi-Disciplinary Approach to the Study of Chronic Pelvic Pain) Research Network 424 participants completed questionnaires, including GUPI (Genitourinary Pain Index), ICSI (Interstitial Cystitis Symptom Index) and ICPI (Interstitial Cystitis Problem Index). Individual items from questionnaires about bladder and pain symptoms were evaluated by principal component and exploratory factor analyses to identify indexes with fewer questions to comprehensively quantify symptom severity. Additional analyses included correlating symptom indexes with symptoms of depression, which is a known comorbidity of patients with pelvic pain. RESULTS AND CONCLUSIONS Exploratory factor analyses suggested that the 2 factors pain severity and urinary severity provided the best psychometric description of items in GUPI, ICSI and ICPI. These factors were used to create 2 symptom indexes for pain and urinary symptoms. Pain, but not urinary symptoms, was associated with symptoms of depression on multiple regression analysis, suggesting that these symptoms may impact patients with urological chronic pelvic pain syndromes differently (B ± SE for pain severity = 0.24 ± 0.04, 95% CI 0.16-0.32, β = 0.32, p <0.001). Our results suggest that pain and urinary symptoms should be assessed separately rather than combined into 1 total score. Total scores that combine the separate factors of pain and urinary symptoms into 1 score may be limited for clinical and research purposes.
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Affiliation(s)
- James W Griffith
- Northwestern University (JWG, RBL), Chicago, Illinois; NorthShore University HealthSystem (FT), Chicago, Illinois; University of Chicago (FT), Chicago, Illinois; University of Pennsylvania (AJS-S, XH, JRL), Philadelphia, Pennsylvania; Temple University (MP), Philadelphia, Pennsylvania; University of California-Los Angeles (BDN), Los Angeles, California; Cedars-Sinai Medical Center (JK), Los Angeles, California; University of California-San Diego and Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego (NA), California; University of Washington (TCE, JNK), Seattle, Washington; University of Michigan (DAW, JQC), Ann Arbor, Michigan; National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health (CM, JWK), Bethesda, Maryland; Washington University in St. Louis (SS, BAH, HHL), St. Louis, Missouri; University of Iowa (CSB), Iowa City, Iowa.
| | - Alisa J Stephens-Shields
- Northwestern University (JWG, RBL), Chicago, Illinois; NorthShore University HealthSystem (FT), Chicago, Illinois; University of Chicago (FT), Chicago, Illinois; University of Pennsylvania (AJS-S, XH, JRL), Philadelphia, Pennsylvania; Temple University (MP), Philadelphia, Pennsylvania; University of California-Los Angeles (BDN), Los Angeles, California; Cedars-Sinai Medical Center (JK), Los Angeles, California; University of California-San Diego and Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego (NA), California; University of Washington (TCE, JNK), Seattle, Washington; University of Michigan (DAW, JQC), Ann Arbor, Michigan; National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health (CM, JWK), Bethesda, Maryland; Washington University in St. Louis (SS, BAH, HHL), St. Louis, Missouri; University of Iowa (CSB), Iowa City, Iowa
| | - Xiaoling Hou
- Northwestern University (JWG, RBL), Chicago, Illinois; NorthShore University HealthSystem (FT), Chicago, Illinois; University of Chicago (FT), Chicago, Illinois; University of Pennsylvania (AJS-S, XH, JRL), Philadelphia, Pennsylvania; Temple University (MP), Philadelphia, Pennsylvania; University of California-Los Angeles (BDN), Los Angeles, California; Cedars-Sinai Medical Center (JK), Los Angeles, California; University of California-San Diego and Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego (NA), California; University of Washington (TCE, JNK), Seattle, Washington; University of Michigan (DAW, JQC), Ann Arbor, Michigan; National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health (CM, JWK), Bethesda, Maryland; Washington University in St. Louis (SS, BAH, HHL), St. Louis, Missouri; University of Iowa (CSB), Iowa City, Iowa
| | - Bruce D Naliboff
- Northwestern University (JWG, RBL), Chicago, Illinois; NorthShore University HealthSystem (FT), Chicago, Illinois; University of Chicago (FT), Chicago, Illinois; University of Pennsylvania (AJS-S, XH, JRL), Philadelphia, Pennsylvania; Temple University (MP), Philadelphia, Pennsylvania; University of California-Los Angeles (BDN), Los Angeles, California; Cedars-Sinai Medical Center (JK), Los Angeles, California; University of California-San Diego and Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego (NA), California; University of Washington (TCE, JNK), Seattle, Washington; University of Michigan (DAW, JQC), Ann Arbor, Michigan; National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health (CM, JWK), Bethesda, Maryland; Washington University in St. Louis (SS, BAH, HHL), St. Louis, Missouri; University of Iowa (CSB), Iowa City, Iowa
| | - Michel Pontari
- Northwestern University (JWG, RBL), Chicago, Illinois; NorthShore University HealthSystem (FT), Chicago, Illinois; University of Chicago (FT), Chicago, Illinois; University of Pennsylvania (AJS-S, XH, JRL), Philadelphia, Pennsylvania; Temple University (MP), Philadelphia, Pennsylvania; University of California-Los Angeles (BDN), Los Angeles, California; Cedars-Sinai Medical Center (JK), Los Angeles, California; University of California-San Diego and Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego (NA), California; University of Washington (TCE, JNK), Seattle, Washington; University of Michigan (DAW, JQC), Ann Arbor, Michigan; National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health (CM, JWK), Bethesda, Maryland; Washington University in St. Louis (SS, BAH, HHL), St. Louis, Missouri; University of Iowa (CSB), Iowa City, Iowa
| | - Todd C Edwards
- Northwestern University (JWG, RBL), Chicago, Illinois; NorthShore University HealthSystem (FT), Chicago, Illinois; University of Chicago (FT), Chicago, Illinois; University of Pennsylvania (AJS-S, XH, JRL), Philadelphia, Pennsylvania; Temple University (MP), Philadelphia, Pennsylvania; University of California-Los Angeles (BDN), Los Angeles, California; Cedars-Sinai Medical Center (JK), Los Angeles, California; University of California-San Diego and Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego (NA), California; University of Washington (TCE, JNK), Seattle, Washington; University of Michigan (DAW, JQC), Ann Arbor, Michigan; National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health (CM, JWK), Bethesda, Maryland; Washington University in St. Louis (SS, BAH, HHL), St. Louis, Missouri; University of Iowa (CSB), Iowa City, Iowa
| | - David A Williams
- Northwestern University (JWG, RBL), Chicago, Illinois; NorthShore University HealthSystem (FT), Chicago, Illinois; University of Chicago (FT), Chicago, Illinois; University of Pennsylvania (AJS-S, XH, JRL), Philadelphia, Pennsylvania; Temple University (MP), Philadelphia, Pennsylvania; University of California-Los Angeles (BDN), Los Angeles, California; Cedars-Sinai Medical Center (JK), Los Angeles, California; University of California-San Diego and Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego (NA), California; University of Washington (TCE, JNK), Seattle, Washington; University of Michigan (DAW, JQC), Ann Arbor, Michigan; National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health (CM, JWK), Bethesda, Maryland; Washington University in St. Louis (SS, BAH, HHL), St. Louis, Missouri; University of Iowa (CSB), Iowa City, Iowa
| | - J Quentin Clemens
- Northwestern University (JWG, RBL), Chicago, Illinois; NorthShore University HealthSystem (FT), Chicago, Illinois; University of Chicago (FT), Chicago, Illinois; University of Pennsylvania (AJS-S, XH, JRL), Philadelphia, Pennsylvania; Temple University (MP), Philadelphia, Pennsylvania; University of California-Los Angeles (BDN), Los Angeles, California; Cedars-Sinai Medical Center (JK), Los Angeles, California; University of California-San Diego and Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego (NA), California; University of Washington (TCE, JNK), Seattle, Washington; University of Michigan (DAW, JQC), Ann Arbor, Michigan; National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health (CM, JWK), Bethesda, Maryland; Washington University in St. Louis (SS, BAH, HHL), St. Louis, Missouri; University of Iowa (CSB), Iowa City, Iowa
| | - Niloofar Afari
- Northwestern University (JWG, RBL), Chicago, Illinois; NorthShore University HealthSystem (FT), Chicago, Illinois; University of Chicago (FT), Chicago, Illinois; University of Pennsylvania (AJS-S, XH, JRL), Philadelphia, Pennsylvania; Temple University (MP), Philadelphia, Pennsylvania; University of California-Los Angeles (BDN), Los Angeles, California; Cedars-Sinai Medical Center (JK), Los Angeles, California; University of California-San Diego and Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego (NA), California; University of Washington (TCE, JNK), Seattle, Washington; University of Michigan (DAW, JQC), Ann Arbor, Michigan; National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health (CM, JWK), Bethesda, Maryland; Washington University in St. Louis (SS, BAH, HHL), St. Louis, Missouri; University of Iowa (CSB), Iowa City, Iowa
| | - Frank Tu
- Northwestern University (JWG, RBL), Chicago, Illinois; NorthShore University HealthSystem (FT), Chicago, Illinois; University of Chicago (FT), Chicago, Illinois; University of Pennsylvania (AJS-S, XH, JRL), Philadelphia, Pennsylvania; Temple University (MP), Philadelphia, Pennsylvania; University of California-Los Angeles (BDN), Los Angeles, California; Cedars-Sinai Medical Center (JK), Los Angeles, California; University of California-San Diego and Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego (NA), California; University of Washington (TCE, JNK), Seattle, Washington; University of Michigan (DAW, JQC), Ann Arbor, Michigan; National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health (CM, JWK), Bethesda, Maryland; Washington University in St. Louis (SS, BAH, HHL), St. Louis, Missouri; University of Iowa (CSB), Iowa City, Iowa
| | - R Brett Lloyd
- Northwestern University (JWG, RBL), Chicago, Illinois; NorthShore University HealthSystem (FT), Chicago, Illinois; University of Chicago (FT), Chicago, Illinois; University of Pennsylvania (AJS-S, XH, JRL), Philadelphia, Pennsylvania; Temple University (MP), Philadelphia, Pennsylvania; University of California-Los Angeles (BDN), Los Angeles, California; Cedars-Sinai Medical Center (JK), Los Angeles, California; University of California-San Diego and Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego (NA), California; University of Washington (TCE, JNK), Seattle, Washington; University of Michigan (DAW, JQC), Ann Arbor, Michigan; National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health (CM, JWK), Bethesda, Maryland; Washington University in St. Louis (SS, BAH, HHL), St. Louis, Missouri; University of Iowa (CSB), Iowa City, Iowa
| | - Donald L Patrick
- Northwestern University (JWG, RBL), Chicago, Illinois; NorthShore University HealthSystem (FT), Chicago, Illinois; University of Chicago (FT), Chicago, Illinois; University of Pennsylvania (AJS-S, XH, JRL), Philadelphia, Pennsylvania; Temple University (MP), Philadelphia, Pennsylvania; University of California-Los Angeles (BDN), Los Angeles, California; Cedars-Sinai Medical Center (JK), Los Angeles, California; University of California-San Diego and Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego (NA), California; University of Washington (TCE, JNK), Seattle, Washington; University of Michigan (DAW, JQC), Ann Arbor, Michigan; National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health (CM, JWK), Bethesda, Maryland; Washington University in St. Louis (SS, BAH, HHL), St. Louis, Missouri; University of Iowa (CSB), Iowa City, Iowa
| | - Chris Mullins
- Northwestern University (JWG, RBL), Chicago, Illinois; NorthShore University HealthSystem (FT), Chicago, Illinois; University of Chicago (FT), Chicago, Illinois; University of Pennsylvania (AJS-S, XH, JRL), Philadelphia, Pennsylvania; Temple University (MP), Philadelphia, Pennsylvania; University of California-Los Angeles (BDN), Los Angeles, California; Cedars-Sinai Medical Center (JK), Los Angeles, California; University of California-San Diego and Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego (NA), California; University of Washington (TCE, JNK), Seattle, Washington; University of Michigan (DAW, JQC), Ann Arbor, Michigan; National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health (CM, JWK), Bethesda, Maryland; Washington University in St. Louis (SS, BAH, HHL), St. Louis, Missouri; University of Iowa (CSB), Iowa City, Iowa
| | - John W Kusek
- Northwestern University (JWG, RBL), Chicago, Illinois; NorthShore University HealthSystem (FT), Chicago, Illinois; University of Chicago (FT), Chicago, Illinois; University of Pennsylvania (AJS-S, XH, JRL), Philadelphia, Pennsylvania; Temple University (MP), Philadelphia, Pennsylvania; University of California-Los Angeles (BDN), Los Angeles, California; Cedars-Sinai Medical Center (JK), Los Angeles, California; University of California-San Diego and Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego (NA), California; University of Washington (TCE, JNK), Seattle, Washington; University of Michigan (DAW, JQC), Ann Arbor, Michigan; National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health (CM, JWK), Bethesda, Maryland; Washington University in St. Louis (SS, BAH, HHL), St. Louis, Missouri; University of Iowa (CSB), Iowa City, Iowa
| | - Siobhan Sutcliffe
- Northwestern University (JWG, RBL), Chicago, Illinois; NorthShore University HealthSystem (FT), Chicago, Illinois; University of Chicago (FT), Chicago, Illinois; University of Pennsylvania (AJS-S, XH, JRL), Philadelphia, Pennsylvania; Temple University (MP), Philadelphia, Pennsylvania; University of California-Los Angeles (BDN), Los Angeles, California; Cedars-Sinai Medical Center (JK), Los Angeles, California; University of California-San Diego and Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego (NA), California; University of Washington (TCE, JNK), Seattle, Washington; University of Michigan (DAW, JQC), Ann Arbor, Michigan; National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health (CM, JWK), Bethesda, Maryland; Washington University in St. Louis (SS, BAH, HHL), St. Louis, Missouri; University of Iowa (CSB), Iowa City, Iowa
| | - Barry A Hong
- Northwestern University (JWG, RBL), Chicago, Illinois; NorthShore University HealthSystem (FT), Chicago, Illinois; University of Chicago (FT), Chicago, Illinois; University of Pennsylvania (AJS-S, XH, JRL), Philadelphia, Pennsylvania; Temple University (MP), Philadelphia, Pennsylvania; University of California-Los Angeles (BDN), Los Angeles, California; Cedars-Sinai Medical Center (JK), Los Angeles, California; University of California-San Diego and Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego (NA), California; University of Washington (TCE, JNK), Seattle, Washington; University of Michigan (DAW, JQC), Ann Arbor, Michigan; National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health (CM, JWK), Bethesda, Maryland; Washington University in St. Louis (SS, BAH, HHL), St. Louis, Missouri; University of Iowa (CSB), Iowa City, Iowa
| | - H Henry Lai
- Northwestern University (JWG, RBL), Chicago, Illinois; NorthShore University HealthSystem (FT), Chicago, Illinois; University of Chicago (FT), Chicago, Illinois; University of Pennsylvania (AJS-S, XH, JRL), Philadelphia, Pennsylvania; Temple University (MP), Philadelphia, Pennsylvania; University of California-Los Angeles (BDN), Los Angeles, California; Cedars-Sinai Medical Center (JK), Los Angeles, California; University of California-San Diego and Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego (NA), California; University of Washington (TCE, JNK), Seattle, Washington; University of Michigan (DAW, JQC), Ann Arbor, Michigan; National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health (CM, JWK), Bethesda, Maryland; Washington University in St. Louis (SS, BAH, HHL), St. Louis, Missouri; University of Iowa (CSB), Iowa City, Iowa
| | - John N Krieger
- Northwestern University (JWG, RBL), Chicago, Illinois; NorthShore University HealthSystem (FT), Chicago, Illinois; University of Chicago (FT), Chicago, Illinois; University of Pennsylvania (AJS-S, XH, JRL), Philadelphia, Pennsylvania; Temple University (MP), Philadelphia, Pennsylvania; University of California-Los Angeles (BDN), Los Angeles, California; Cedars-Sinai Medical Center (JK), Los Angeles, California; University of California-San Diego and Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego (NA), California; University of Washington (TCE, JNK), Seattle, Washington; University of Michigan (DAW, JQC), Ann Arbor, Michigan; National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health (CM, JWK), Bethesda, Maryland; Washington University in St. Louis (SS, BAH, HHL), St. Louis, Missouri; University of Iowa (CSB), Iowa City, Iowa
| | - Catherine S Bradley
- Northwestern University (JWG, RBL), Chicago, Illinois; NorthShore University HealthSystem (FT), Chicago, Illinois; University of Chicago (FT), Chicago, Illinois; University of Pennsylvania (AJS-S, XH, JRL), Philadelphia, Pennsylvania; Temple University (MP), Philadelphia, Pennsylvania; University of California-Los Angeles (BDN), Los Angeles, California; Cedars-Sinai Medical Center (JK), Los Angeles, California; University of California-San Diego and Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego (NA), California; University of Washington (TCE, JNK), Seattle, Washington; University of Michigan (DAW, JQC), Ann Arbor, Michigan; National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health (CM, JWK), Bethesda, Maryland; Washington University in St. Louis (SS, BAH, HHL), St. Louis, Missouri; University of Iowa (CSB), Iowa City, Iowa
| | - Jayoung Kim
- Northwestern University (JWG, RBL), Chicago, Illinois; NorthShore University HealthSystem (FT), Chicago, Illinois; University of Chicago (FT), Chicago, Illinois; University of Pennsylvania (AJS-S, XH, JRL), Philadelphia, Pennsylvania; Temple University (MP), Philadelphia, Pennsylvania; University of California-Los Angeles (BDN), Los Angeles, California; Cedars-Sinai Medical Center (JK), Los Angeles, California; University of California-San Diego and Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego (NA), California; University of Washington (TCE, JNK), Seattle, Washington; University of Michigan (DAW, JQC), Ann Arbor, Michigan; National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health (CM, JWK), Bethesda, Maryland; Washington University in St. Louis (SS, BAH, HHL), St. Louis, Missouri; University of Iowa (CSB), Iowa City, Iowa
| | - J Richard Landis
- Northwestern University (JWG, RBL), Chicago, Illinois; NorthShore University HealthSystem (FT), Chicago, Illinois; University of Chicago (FT), Chicago, Illinois; University of Pennsylvania (AJS-S, XH, JRL), Philadelphia, Pennsylvania; Temple University (MP), Philadelphia, Pennsylvania; University of California-Los Angeles (BDN), Los Angeles, California; Cedars-Sinai Medical Center (JK), Los Angeles, California; University of California-San Diego and Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego (NA), California; University of Washington (TCE, JNK), Seattle, Washington; University of Michigan (DAW, JQC), Ann Arbor, Michigan; National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health (CM, JWK), Bethesda, Maryland; Washington University in St. Louis (SS, BAH, HHL), St. Louis, Missouri; University of Iowa (CSB), Iowa City, Iowa
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Woodworth D, Mayer E, Leu K, Ashe-McNalley C, Naliboff BD, Labus JS, Tillisch K, Kutch JJ, Farmer MA, Apkarian AV, Johnson KA, Mackey SC, Ness TJ, Landis JR, Deutsch G, Harris RE, Clauw DJ, Mullins C, Ellingson BM. Unique Microstructural Changes in the Brain Associated with Urological Chronic Pelvic Pain Syndrome (UCPPS) Revealed by Diffusion Tensor MRI, Super-Resolution Track Density Imaging, and Statistical Parameter Mapping: A MAPP Network Neuroimaging Study. PLoS One 2015; 10:e0140250. [PMID: 26460744 PMCID: PMC4604194 DOI: 10.1371/journal.pone.0140250] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 09/23/2015] [Indexed: 12/27/2022] Open
Abstract
Studies have suggested chronic pain syndromes are associated with neural reorganization in specific regions associated with perception, processing, and integration of pain. Urological chronic pelvic pain syndrome (UCPPS) represents a collection of pain syndromes characterized by pelvic pain, namely Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) and Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS), that are both poorly understood in their pathophysiology, and treated ineffectively. We hypothesized patients with UCPPS may have microstructural differences in the brain compared with healthy control subjects (HCs), as well as patients with irritable bowel syndrome (IBS), a common gastrointestinal pain disorder. In the current study we performed population-based voxel-wise DTI and super-resolution track density imaging (TDI) in a large, two-center sample of phenotyped patients from the multicenter cohort with UCPPS (N = 45), IBS (N = 39), and HCs (N = 56) as part of the MAPP Research Network. Compared with HCs, UCPPS patients had lower fractional anisotropy (FA), lower generalized anisotropy (GA), lower track density, and higher mean diffusivity (MD) in brain regions commonly associated with perception and integration of pain information. Results also showed significant differences in specific anatomical regions in UCPPS patients when compared with IBS patients, consistent with microstructural alterations specific to UCPPS. While IBS patients showed clear sex related differences in FA, MD, GA, and track density consistent with previous reports, few such differences were observed in UCPPS patients. Heat maps illustrating the correlation between specific regions of interest and various pain and urinary symptom scores showed clustering of significant associations along the cortico-basal ganglia-thalamic-cortical loop associated with pain integration, modulation, and perception. Together, results suggest patients with UCPPS have extensive microstructural differences within the brain, many specific to syndrome UCPPS versus IBS, that appear to be localized to regions associated with perception and integration of sensory information and pain modulation, and seem to be a consequence of longstanding pain.
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Affiliation(s)
- Davis Woodworth
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Biomedical Physics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Oppenheimer Center for the Neurobiology of Stress, and PAIN, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Emeran Mayer
- Oppenheimer Center for the Neurobiology of Stress, and PAIN, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Digestive Diseases and Gastroenterology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Kevin Leu
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Bioengineering, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Cody Ashe-McNalley
- Oppenheimer Center for the Neurobiology of Stress, and PAIN, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Digestive Diseases and Gastroenterology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Bruce D. Naliboff
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Jennifer S. Labus
- Oppenheimer Center for the Neurobiology of Stress, and PAIN, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Digestive Diseases and Gastroenterology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Kirsten Tillisch
- Oppenheimer Center for the Neurobiology of Stress, and PAIN, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Digestive Diseases and Gastroenterology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Jason J. Kutch
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, United States of America
| | - Melissa A. Farmer
- Department of Physiology, Northwestern University, Chicago, Illinois, United States of America
| | - A. Vania Apkarian
- Department of Physiology, Northwestern University, Chicago, Illinois, United States of America
| | - Kevin A. Johnson
- Department of Neurology, Stanford University, Palo Alto, California, United States of America
| | - Sean C. Mackey
- Department of Neurology, Stanford University, Palo Alto, California, United States of America
| | - Timothy J. Ness
- Department of Anesthesiology, University of Alabama, Birmingham, Alabama, United States of America
| | - J. Richard Landis
- Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Georg Deutsch
- Department of Radiology, University of Alabama, Birmingham, Alabama, United States of America
| | - Richard E. Harris
- Department of Anestesiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Daniel J. Clauw
- Department of Anestesiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Chris Mullins
- Division of Kidney, Urologic, and Hematologic Diseases; National Institute of Diabetes and Digestive and Kidney Diseases; National Institutes of Health, Bethesda, Maryland, United States of America
| | - Benjamin M. Ellingson
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Biomedical Physics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Oppenheimer Center for the Neurobiology of Stress, and PAIN, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Bioengineering, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
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