Role of psychosocial factors of symptom flares in a cohort of patients with chronic urologic pelvic pain syndrome: A cognitive-affective approach

Little is known about cognitive-affective factors associated with symptom exacerbations (“flares”) in individuals with Urologic Chronic Pelvic Pain Syndrome (UCPPS) even though pain is its cardinal feature and a defining attribute of flares which are regarded as a global marker of illness severity. Disease activity is unable to explain UCPPS flares because its pathophysiology involves altered pain modulation in the central nervous system independent of peripheral pain input. We sought to characterize how different psychosocial factors correspond with distinct flare attributes in UCPPS patients. Subjects included 92 formally diagnosed UCPPS (Interstitial Cystitis/Bladder Pain Syndrome or Chronic Prostatitis/Chronic Pelvic Pain Syndrome) patients (M_age = 43, SD = 14, 82 % female) with refractory pelvic pain. Data, completed as part of baseline evaluation of an NIH clinical trial, included the Pain Discomfort Scale (pain-related suffering), Coping Strategies Questionnaire, Catastrophizing subscale, revised McGill Pain Inventory-Short Form (pain quality), Positive and Negative Affect Scale, Childhood Trauma Questionnaire, as well as flare and UCPPS symptom measures. Regression analyses were applied to characterize the association between psychosocial factors and flare dimensions. Psychosocial factors were broadly associated with multiple flare attributes. Their combined effect was strongest for flare severity with mood, and pain-related suffering, as significant predictors. This investigation breaks new ground by linking psychosocial risk factors to multiple dimensions of UCPPS flares. Further studies are needed to leverage this line of research to develop behaviorally-based flare management programs that strengthen patients’ self-regulatory capacity for reducing flares, thereby decreasing the public health burden of UCPPS.