Symptom Variability and Early Symptom Regression in the MAPP Study: A Prospective Study of Urological Chronic Pelvic Pain Syndrome

Alisa Stephens, J. Quentin Clemens, Thomas Jemielita, John T. Farrar, Siobhan Sutcliffe, Xiaoling Hou, J. Richard Landis, Philip Hanno, Ziya Kirkali, John W. Kusek, M. Scott Lucia, Robert M. Moldwin, Chris Mullins, Michel A. Pontari, David J. Klumpp, Anthony J. Schaeffer, Apkar (Vania) Apkarian, David Cella, Melissa A. Farmer, Colleen FitzgeraldRichard Gershon, James W. Griffith, Charles J. Heckman, Mingchen Jiang, Laurie Keefer, Darlene S. Marko, Jean Michniewicz, Todd Parrish, Frank Tu, Emeran A. Mayer, Larissa V. Rodríguez, Jeffry Alger, Cody P. Ashe-McNalley, Ben Ellingson, Nuwanthi Heendeniya, Lisa Kilpatrick, Cara Kulbacki, 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, Suzie As-Sanie, Sandra Berry, Clara Grayhack, 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, Kelly Robertson, Susan O. Ross, Roberta Spiro, TJ 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, Jeffrey P Henderson, Barry A. Hong, Thomas M. Hooton, Timothy J. Ness, Carol S. North, Theresa M. Spitznagle, Jennifer Anger, Michael Freeman, Jayoung Kim, Karyn Eilber, Jennifer Van Eyk, Wei Yang, Vincent Funari, Jeena Cha, Ted Barrell, Ro- Pauline Doe, Laura Gallagher, Tamara Howard, Nancy Robinson, Sandra Smith, Alisa Stephens, Yanli Wang, Xingmei Wang, Adrie van Bokhoven, Andrea A. Osypuk, Robert Dayton, Karen R. Jonscher, Holly T. Sullivan, R. Storey Wilson, 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, Garth D. Ehrlich, Tamara G. Bavendam

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


PURPOSE We examined symptom variability in men and women with urological chronic pelvic pain syndrome. We describe symptom fluctuations as related to early symptom regression and its effect on estimated 1-year symptom change. We also describe a method to quantify patient specific symptom variability. MATERIALS AND METHODS Symptoms were assessed biweekly in 424 subjects with urological chronic pelvic pain syndrome during 1 year. To evaluate the impact of early symptom regression subjects were classified as improved, no change or worse according to the rate of change using 1) all data, 2) excluding week 0 and 3) excluding weeks 0 and 2. Patient specific, time varying variability was calculated at each interval using a sliding window approach. Patients were classified as high, medium or low variability at each time and ultimately as high or low variability overall based on the variability for the majority of contacts. RESULTS Prior to excluding early weeks to adjust for early symptom regression 25% to 38% and 5% to 6% of patients were classified as improved and worse, respectively. After adjustment the percent of patients who were improved or worse ranged from 15% to 25% and 6% to 9%, respectively. High and low variability phenotypes were each identified in 25% to 30% of participants. CONCLUSIONS Patients with urological chronic pelvic pain syndrome show symptom variability. At study enrollment patients had worse symptoms on average, resulting in a regression effect that influenced the estimated proportion of those who were improved or worse. Prospective studies should include a run-in period to account for regression to the mean and other causes of early symptom regression. Further, symptom variability may be quantified and used to characterize longitudinal symptom profiles of urological chronic pelvic pain syndrome.
Original languageEnglish (US)
Pages (from-to)1450-1455
Number of pages6
JournalThe Journal of Urology
Issue number5
StatePublished - 2016


  • cystitis
  • epidemiologic research design
  • interstitial
  • pain
  • prostate
  • symptom assessment


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