The University of Michigan MAPP Discovery Site has provided significant leadership to the first phase of the Multidisciplinary Approach to Chronic Pelvic Pain (MAPP) effort to study urinary chronic pelvic pain syndromes (UCPPS). We provided the initial (Clauw) and current (Clemens) network chairs, and leadership in phenotyping (Williams), quantitative sensory testing (Harte) and neuroimaging (Harris). In addition, we were an excellent recruitment site for the MAPP, with total numbers of participants enrolled (186) and retention of participants (92%) amongst the highest of any site. We propose to similarly provide organizational and scientific leadership in Phase II of the MAPP. In addition to the performance of the UCPPS Symptom Pattern Study, we propose three additional aims we believe bring innovative research methods and expertise to the broader trans-MAPP efforts.
These aims are: 1) To continue our effective participation in trans-MAPP studies, including the UCPPS Symptom Patterns Study. 2) To perform an Interventional Phenotyping study that can either be immediately adopted trans-MAPP or serve as a pilot for a broader trans-MAPP effort in Phase II. This will be the first study ever to hypothesize that symptom profiles, quantitative sensory testing and functional neuroimaging can be used to identify subsets of UCPPS patients (endo-phenotypes) that have differing underlying mechanisms and thus will respond to different treatments. In particular, we hypothesize that we can predict differential responsiveness to a UCPPS treatment thought to work primarily via central mechanisms (a tricyclic compound) vs. one that is primarily though to work via more peripheral mechanisms (a NSAID). 3) To provide guidance and expertise for trans-MAPP genetic efforts. We propose to bring several colleagues with internationally recognized expertise in genetics into the MAPP to help inform and guide our trans-MAPP efforts, including the best strategies to use to analyze both Phase I and II samples. We hypothesize that genetic variations will facilitate the identification of endo-phenotypes as well as the longitudinal course of UCPPS. 4) To provide a broader and more comprehensive set of quantitative sensory testing (QST) measures into the Phase II MAPP studies. Our group led the QST efforts in MAPP I, and for MAPP II have partnered with the UCLA site to implement an expanded QST testing protocol, including Conditioned Pain Modulation (CPM), and assessment of thresholds for other sensory experiences (visual, auditory). We hypothesize that QST will allow us to better separate endo-phenotypes (especially by identifying UCPPS participants with pan-sensory hyper-responsiveness that is clearly CNS in origin) as well as predict longitudinal course.

Public Health Relevance

The University of Michigan MAPP discovery site was successful in providing scientific and organizational leadership and high recruitment and retention of research participants in Phase I. For Phase II we propose to do the same. In addition to being active participants in the Symptom Pattern Study that will serve as the main Phase II trans-MAPP study, we propose additional studies involving interventional phenotyping, genetics, and quantitative sensory testing that could also be incorporated into Phase II of the MAPP effort.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Project--Cooperative Agreements (U01)
Project #
2U01DK082345-06
Application #
8776113
Study Section
Special Emphasis Panel ()
Program Officer
Mullins, Christopher V
Project Start
2008-09-15
Project End
2019-06-30
Budget Start
2014-09-18
Budget End
2015-06-30
Support Year
6
Fiscal Year
2014
Total Cost
$914,668
Indirect Cost
$318,668
Name
University of Michigan Ann Arbor
Department
Anesthesiology
Type
Schools of Medicine
DUNS #
073133571
City
Ann Arbor
State
MI
Country
United States
Zip Code
48109
Alger, Jeffry R; Ellingson, Benjamin M; Ashe-McNalley, Cody et al. (2016) Multisite, multimodal neuroimaging of chronic urological pelvic pain: Methodology of the MAPP Research Network. Neuroimage Clin 12:65-77
Nickel, J Curtis; Stephens, Alisa; Landis, J Richard et al. (2016) Assessment of the Lower Urinary Tract Microbiota during Symptom Flare in Women with Urologic Chronic Pelvic Pain Syndrome: A MAPP Network Study. J Urol 195:356-62
Williams, David A (2016) Cognitive - Behavioral Therapy in Central Sensitivity Syndromes. Curr Rheumatol Rev 12:2-12
Stephens-Shields, Alisa J; Clemens, J Quentin; Jemielita, Thomas et al. (2016) Symptom Variability and Early Symptom Regression in the MAPP Study: A Prospective Study of Urological Chronic Pelvic Pain Syndrome. J Urol 196:1450-1455
Huang, Lejian; Kutch, Jason J; Ellingson, Benjamin M et al. (2016) Brain white matter changes associated with urological chronic pelvic pain syndrome: multisite neuroimaging from a MAPP case-control study. Pain 157:2782-2791
Harte, Steven E; Ichesco, Eric; Hampson, Johnson P et al. (2016) Pharmacologic attenuation of cross-modal sensory augmentation within the chronic pain insula. Pain 157:1933-45
Griffith, James W; Stephens-Shields, Alisa J; Hou, Xiaoling et al. (2016) Pain and Urinary Symptoms Should Not be Combined into a Single Score: Psychometric Findings from the MAPP Research Network. J Urol 195:949-54
Williams, David A; Kratz, Anna L (2016) Patient-Reported Outcomes and Fibromyalgia. Rheum Dis Clin North Am 42:317-32
Naliboff, Bruce D; Stephens, Alisa J; Afari, Niloo et al. (2015) Widespread Psychosocial Difficulties in Men and Women With Urologic Chronic Pelvic Pain Syndromes: Case-control Findings From the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network. Urology 85:1319-27
Martucci, Katherine T; Shirer, William R; Bagarinao, Epifanio et al. (2015) The posterior medial cortex in urologic chronic pelvic pain syndrome: detachment from default mode network-a resting-state study from the MAPP Research Network. Pain 156:1755-64

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