Trans-MAPP Symptom Patterns Study (SPS)
Trans-MAPP Symptom Patterns Study (SPS)
This study is the second phase of the MAPP Network and is designed to conduct a prospective,
 observational study of men and women with UCPPS, referred to as the Symptom Patterns Study
 (SPS), enriched with pre-defined subgroups, with longer follow-up, in order to further
 investigate clinical and biologic factors associated with worsening and/or improvement of
 reported urinary and non-urinary symptoms.
To better understand the etiology and treated natural history of UCPPS, and to identify
 clinical factors and research measurements to define clinically relevant sub-groups of these
 patients for future clinical trials, and to inform symptom management, the NIDDK established
 the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network in
 20089 (http://www.mappnetwork.org/). The primary clinical research effort carried out by this
 network in Phase I was a prospective cohort study, the Trans-MAPP Epidemiology/Phenotyping
 (EP) Study.10 From 12/14/2009 through 12/14/2012 1,039 men and women were enrolled, including
 persons with UCPPS (n=424); persons with other co-morbid illnesses, including fibromyalgia,
 irritable bowel syndrome, and chronic fatigue syndrome (n=200 for all conditions); and
 healthy controls (n=415). Study participants were extensively characterized (i.e.,
 phenotyped) at baseline, and UCPPS participants were followed for 12 months. During
 follow-up, using a web-based symptom data capture system, a small battery of self-report
 questionnaires were repeated on a bi-weekly schedule for 48 weeks. In addition, neuroimaging
 was performed in a subset of participants (n=279) at baseline, and biological samples were
 collected on all participants at baseline and follow-up for studies to identify plasma and
 urine biomarkers and potential infectious agents. This study was complemented by a number of
 Discovery Site-Specific clinical research studies (i.e., studies generally conducted at a
 single site) and investigations of animal models developed by multiple sites to mimic
 symptoms of human UCPPS.

 Initial analyses of these data have identified a number of provocative findings. There are
 strong indications those certain subgroups of participants (albeit with small sample sizes)
 with urinary and non-urinary symptoms tend to improve over time; whereas other subgroups tend
 to worsen over time. These patterns of improving or worsening are differentially expressed
 according to sex, subtype of bladder pain syndrome (BPS), and pain location (localized to the
 pelvic region vs pain reported in the pelvic region and beyond).

 The second phase of the MAPP Network is designed to conduct a prospective, observational
 study of men and women with UCPPS, referred to as the Symptom Patterns Study (SPS). This
 follow-up study will have pre-defined subgroups, with longer follow-up, in order to further
 investigate clinical and biologic factors associated with worsening and/or improvement of
 reported urinary and non-urinary symptoms.

 This proposed MAPP Phase II SPS also presents the opportunity to apply many of the most
 promising research methods in the pain field (e.g. functional, chemical and structural
 neuroimaging, quantitative sensory testing) during the course of the study (at baseline and
 then longitudinally) to better characterize men and women with UCPPS. Most of these measures
 were only collected at a single point in time in the Trans-MAPP Epidemiology/Phenotyping
 Study of Phase I, and within a sample of UCPPS patients not enriched with predefined
 subgroups. Further phenotyping in the second phase study will allow us to better determine
 which of these measures, or any other measures identified during Phase I (e.g., urinary or
 serum biomarkers), might identify individuals most likely to have spontaneous improvement of
 their symptoms, versus transition to a more "peripheral" (pelvic pain only) or "centralized"
 form (pelvic pain and beyond) of urinary and non-urinary pain.

 Eligible participants will be asked to participate in the study for up to 36 months. During
 which they will be asked to complete a series of in-clinic study visits that will at various
 time points a neuroimaging scan and quantitative sensory tests, online internet-based
 questionnaires in clinic and off site/at home (assessing symptoms, health care utilization,
 flare status, and quality of life), a physical exam, a pelvic exam, and prostate massage
 (optional for males only).
Inclusion Criteria:

 Patients are eligible for the SPS if they meet the following criteria:

 1. Participant has signed and dated the appropriate Informed Consent document.

 -  Agreed to participate in ALL required Symptoms Patterns Study procedures
 (including Biospecimen collections, Neuroimaging, and Quantitative Sensory
 Testing).

 -  Gave permission for use of DNA for genetics studies.

 2. Participant is at least 18 years of age.

 3. Participant is able to speak, read, and understand English.

 4. In the past 3 months participant has had a feeling of pain, pressure, or discomfort in
 the lower abdomen or pelvic area -- that is, the part of the body that is above the
 participant's legs and below the belly button.

 5. These symptoms have been present for the majority of the time during the most recent 3
 months.

 6. Participant reports a response of at least 1 on the pain, pressure or discomfort scale
 for UCPPS symptoms during the past 2 weeks.

 7. Participant has received a clinical diagnosis of either or both IC/BPS or CP/CPPS (per
 AUA guidelines) or a clinician familiar with UCPPS criteria confirms participant meets
 UCPPS evaluation criteria per-protocol.

 Exclusion Criteria:

 Any patient meeting any one of the following criteria will not be eligible for enrollment
 in the Symptom Patterns Study. However, participants who develop any of these exclusion
 criteria during the follow-up phase of the study will continue to be followed. It will be
 recorded in the follow-up data if a patient has developed any of the exclusion criteria.

 1. Participant has an on-going symptomatic urethral stricture.

 2. Participant has an on-going neurological disease or disorder affecting the bladder or
 bowel fistula.

 3. Participant has a history of cystitis caused by tuberculosis, radiation therapy or
 Cytoxan/cyclophosphamide therapy.

 4. Participant has augmentation cystoplasty or cystectomy.

 5. Participant has an active autoimmune or infectious disorder (such as Crohn's Disease
 or Ulcerative Colitis, Lupus, Rheumatoid Arthritis, Multiple Sclerosis, or HIV).

 6. Participant has a history of cancer (with the exception of skin cancer).

 7. Participant has current major psychiatric disorder or other psychiatric or medical
 issues that would interfere with study participation (e.g. dementia, psychosis,
 upcoming major surgery, etc.).

 8. Participant has severe cardiac, pulmonary, renal, or hepatic disease that in the
 judgment of the study physician would preclude participation in this study.

 Exclusion Criteria for Males Only

 1. Diagnosis of unilateral orchalgia, without pelvic symptoms.

 2. History of transurethral microwave thermotherapy (TUMT), transurethral needle ablation
 (TUNA), balloon dilation, prostate cryo-surgery, or laser procedure.