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Achieving a better understanding of symptom flares in people with urologic pain syndromes

Scientists studying urologic chronic pelvic pain syndromes (UCPPS) have recently reported on risk factors and variation regarding symptom flares in people—information that could help improve care in the future. People with UCPPS—interstitial cystitis/bladder pain syndrome (IC/BPS) or chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS, in men only)—experience pelvic pain and urologic symptoms, such as urinary frequency and urgency. When one or both sets of symptoms becomes worse for a period of time, this is called a flare. Understanding frequency, duration, and risk factors for flares over time could help in finding ways to manage or prevent them. In a study lasting nearly a year, researchers with the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network collected information about flares from nearly 400 participants. About 75 percent of participants reported having at least one flare, and the duration of flares could be as short as one day or as long as 150 days. Further analyses revealed that both urologic and pelvic pain symptoms worsened during flares, although the degree of worsening in each flare event varied not only between people but also within persons who had multiple flares. Risk of worse and/or longer flares was greater in women, in individuals who had greater than average UCPPS symptoms overall when not having a flare, and in those with bladder pain associated with filling and/ or urgency to urinate (bladder hypersensitivity). Finally, people with UCPPS commonly have co-occurring chronic pain conditions, such as irritable bowel syndrome (IBS), and having IBS or any such pain condition was also a risk factor for worse flares. Based upon their findings, the researchers also generated some new ideas for investigation regarding mechanisms underlying risk and extent of flares, such as the potential involvement of pain pathways both in the central nervous system and in peripheral organs and tissues. This newly acquired knowledge of UCPPS symptom fluctuation over time, risk factors, and variability in flare characteristics both within and between individuals helps to identify subgroups of people with UCPPS, and provides a foundation on which to research further flare management with the ultimate goal of flare prevention.