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A Case-Crossover Study of Urological Chronic Pelvic Pain Syndrome Flare Triggers in the MAPP Research Network

Purpose
Although many factors have been proposed to trigger symptom exacerbations (flares) in patients with interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome, few studies have investigated these factors empirically. Therefore, we embedded a case-crossover study in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain longitudinal study to evaluate a range of patient reported triggers.

Materials and Methods
We assessed exposure to proposed triggers, including diet, physical activities, sedentary behaviors, stress, sexual activities, infection-like symptoms and allergies, by questionnaire a maximum of 3 times when participants reported flares and at 3 randomly selected times. We compared participant preflare to nonflare exposures by conditional logistic regression.

Results
In our full analytical sample of 292 participants only 2 factors, including recent sexual activity (OR 1.44, 95% CI 1.06–1.96) and urinary tract infection symptoms (OR 3.39, 95% CI 2.02–5.68), which may overlap with those of flares, were associated with flare onset. On subanalyses restricted to flares with specific suspected triggers additional positive associations were observed for some factors such as certain dietary factors, abdominal muscle exercises, and vaginal infection-like symptoms and fever, but not for other factors (eg stress).

Conclusions
Except for sexual activity our findings suggest that patient reported triggers may be individual or group specific, or they may not contribute to flares. These findings suggest caution in following rigid, global flare prevention strategies and support additional research to develop evidence-based strategies.


Siobhan Sutcliffe, Thomas Jemielita, H. Henry Lai, Gerald L. Andriole, Catherine S. Bradley, J. Quentin Clemens, Robert Gallop, Thomas M. Hooton, Karl J. Kreder, John N. Krieger, John W. Kusek, Jennifer Labus, M. Scott Lucia, Sean Mackey, Bruce D. Naliboff, Nancy A. Robinson, Larissa V. Rodriguez, Alisa Stephens-Shields, Adrie van Bokhoven, Kathleen Y. Wolin, Yan Yan, Claire C. Yang, J. Richard Landis, Graham A. Colditz for the MAPP Re-search Network
Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
The Journal of Urology, May 2018, Volume 199, Issue 5, Pages 1245–1251
DOI: https://doi.org/10.1016/j.juro.2017.12.050

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