The MAPP research network: a novel study of urologic chronic pelvic pain syndromes

J Quentin Clemens, Chris Mullins, John W Kusek, Ziya Kirkali, Emeran A Mayer, Larissa V Rodríguez, David J Klumpp, Anthony J Schaeffer, Karl J Kreder, Dedra Buchwald, Gerald L Andriole, M Scott Lucia, J Richard Landis, Daniel J Clauw, MAPP Research Network Study Group, J Quentin Clemens, Ziya Kirkali, John W Kusek, J Richard Landis, M Scott Lucia, Chris Mullins, Michel A Pontari, David J Klumpp, Anthony J Schaeffer, Apkar Vania Apkarian, David Cella, Melissa A Farmer, Colleen Fitzgerald, Richard Gershon, James W Griffith, Charles J Heckman 2nd, Mingchen Jiang, Laurie Keefer, Darlene S Marko, Jean Michniewicz, Todd Parrish, Frank Tu, A Mayer, Larissa V Rodríguez, Jeffry Alger, Cody P Ashe-McNalley, Ben Ellingson, Nuwanthi Heendeniya, Lisa Kilpatrick, Jason Kutch, Jennifer S Labus, Bruce D Naliboff, Fornessa Randal, Suzanne R Smith, Karl J Kreder, Catherine S Bradley, Mary Eno, Kris Greiner, Yi Luo, Susan K Lutgendorf, Michael A O'Donnell, Barbara Ziegler, Daniel J Clauw, J Quentin Clemens, Suzie As-Sanie, Sandra Berry, Megan E Halvorson, Richard Harris, Steve Harte, Eric Ichesco, Ann Oldendorf, Katherine A Scott, David A Williams, Dedra Buchwald, Niloofar Afari, John Krieger, Jane Miller, Stephanie Richey, Susan O Ross, Roberta Spiro, T J Sundsvold, Eric Strachan, Claire C Yang, Gerald L Andriole, H Henry Lai, Rebecca L Bristol, Graham Colditz, Georg Deutsch, Vivien C Gardner, Robert W Gereau 4th, Jeffrey P Henderson, Barry A Hong, Thomas M Hooton, Timothy J Ness, Carol S North, Theresa M Spitznagle, Siobhan Sutcliffe, J Richard Landis, Ted Barrell, Philip Hanno, Xiaoling Hou, Tamara Howard, Michel A Pontari, Nancy Robinson, Alisa Stephens, Yanli Wang, M Scott Lucia, Adrie van Bokhoven, Andrea A Osypuk, Robert Dayton Jr, Karen R Jonscher, Holly T Sullivan, R Storey Wilson, Garth D Ehrlich, Marsha A Moses, Andrew C Briscoe, David Briscoe, Adam Curatolo, John Froehlich, Richard S Lee, Monisha Sachdev, Keith R Solomon, Hanno Steen, Sean Mackey, Epifanio Bagarinao, Lauren C Foster, Emily Hubbard, Kevin A Johnson, Katherine T Martucci, Rebecca L McCue, Rachel R Moericke, Aneesha Nilakantan, Noorulain Noor, J Curtis Nickel, Chris Mullins, John W Kusek, Ziya Kirkali, Tamara G Bavendam, J Quentin Clemens, Chris Mullins, John W Kusek, Ziya Kirkali, Emeran A Mayer, Larissa V Rodríguez, David J Klumpp, Anthony J Schaeffer, Karl J Kreder, Dedra Buchwald, Gerald L Andriole, M Scott Lucia, J Richard Landis, Daniel J Clauw, MAPP Research Network Study Group, J Quentin Clemens, Ziya Kirkali, John W Kusek, J Richard Landis, M Scott Lucia, Chris Mullins, Michel A Pontari, David J Klumpp, Anthony J Schaeffer, Apkar Vania Apkarian, David Cella, Melissa A Farmer, Colleen Fitzgerald, Richard Gershon, James W Griffith, Charles J Heckman 2nd, Mingchen Jiang, Laurie Keefer, Darlene S Marko, Jean Michniewicz, Todd Parrish, Frank Tu, A Mayer, Larissa V Rodríguez, Jeffry Alger, Cody P Ashe-McNalley, Ben Ellingson, Nuwanthi Heendeniya, Lisa Kilpatrick, Jason Kutch, Jennifer S Labus, Bruce D Naliboff, Fornessa Randal, Suzanne R Smith, Karl J Kreder, Catherine S Bradley, Mary Eno, Kris Greiner, Yi Luo, Susan K Lutgendorf, Michael A O'Donnell, Barbara Ziegler, Daniel J Clauw, J Quentin Clemens, Suzie As-Sanie, Sandra Berry, Megan E Halvorson, Richard Harris, Steve Harte, Eric Ichesco, Ann Oldendorf, Katherine A Scott, David A Williams, Dedra Buchwald, Niloofar Afari, John Krieger, Jane Miller, Stephanie Richey, Susan O Ross, Roberta Spiro, T J Sundsvold, Eric Strachan, Claire C Yang, Gerald L Andriole, H Henry Lai, Rebecca L Bristol, Graham Colditz, Georg Deutsch, Vivien C Gardner, Robert W Gereau 4th, Jeffrey P Henderson, Barry A Hong, Thomas M Hooton, Timothy J Ness, Carol S North, Theresa M Spitznagle, Siobhan Sutcliffe, J Richard Landis, Ted Barrell, Philip Hanno, Xiaoling Hou, Tamara Howard, Michel A Pontari, Nancy Robinson, Alisa Stephens, Yanli Wang, M Scott Lucia, Adrie van Bokhoven, Andrea A Osypuk, Robert Dayton Jr, Karen R Jonscher, Holly T Sullivan, R Storey Wilson, Garth D Ehrlich, Marsha A Moses, Andrew C Briscoe, David Briscoe, Adam Curatolo, John Froehlich, Richard S Lee, Monisha Sachdev, Keith R Solomon, Hanno Steen, Sean Mackey, Epifanio Bagarinao, Lauren C Foster, Emily Hubbard, Kevin A Johnson, Katherine T Martucci, Rebecca L McCue, Rachel R Moericke, Aneesha Nilakantan, Noorulain Noor, J Curtis Nickel, Chris Mullins, John W Kusek, Ziya Kirkali, Tamara G Bavendam

Abstract

Urologic chronic pelvic pain syndrome (UCPPS) may be defined to include interstitial cystitis/bladder pain syndrome (IC/BPS) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). The hallmark symptom of UCPPS is chronic pain in the pelvis, urogenital floor, or external genitalia often accompanied by lower urinary tract symptoms. Despite numerous past basic and clinical research studies there is no broadly identifiable organ-specific pathology or understanding of etiology or risk factors for UCPPS, and diagnosis relies primarily on patient reported symptoms. In addition, there are no generally effective therapies. Recent findings have, however, revealed associations between UCPPS and "centralized" chronic pain disorders, suggesting UCPPS may represent a local manifestation of more widespread pathology in some patients. Here, we describe a new and novel effort initiated by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the U.S. National Institutes of Health (NIH) to address the many long standing questions regarding UCPPS, the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network. The MAPP Network approaches UCPPS in a systemic manner, in which the interplay between the genitourinary system and other physiological systems is emphasized. The network's study design expands beyond previous research, which has primarily focused on urologic organs and tissues, to utilize integrated approaches to define patient phenotypes, identify clinically-relevant subgroups, and better understand treated natural history and pathophysiology. Thus, the MAPP Network provides an unprecedented, multi-layered characterization of UCPPS. Knowledge gained is expected to provide important insights into underlying pathophysiology, a foundation for better segmenting patients for future clinical trials, and ultimately translation into improved clinical management. In addition, the MAPP Network's integrated multi-disciplinary research approach may serve as a model for studies of urologic and non-urologic disorders that have proven refractory to past basic and clinical study.

Trial registration: ClinicalTrials.gov identifier: NCT01098279 "Chronic Pelvic Pain Study of Individuals with Diagnoses or Symptoms of Interstitial Cystitis and/or Chronic Prostatitis (MAPP-EP)".

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