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Does Early Symptom Regression Influence the Results of Pelvic Pain Studies?

Stephens-Shields AJ, Clemens JQ, Jemielita T, Farrar J, Sutcliffe S, Hou X, Landis JR; MAPP Research Network. Symptom Variability and Early Symptom Regression in the MAPP Study, a Prospective Study of Urological Chronic Pelvic Pain Syndrome. J Urol. 2016 Apr 27. pii: S0022-5347(16)30310-X. doi: 10.1016/j.juro.2016.04.070. [Epub ahead of print]

In this unique analysis, investigators asked whether symptom fluctuations in women and men with urological chronic pelvic pain syndrome (CPPS) had any influence on how patients’ symptoms are categorized. To test this, they assessed symptoms every other week in 424 individuals with CPPS over the course of one year. In particular, they highlighted the influence of early symptom regression, or a tendency for symptoms to improve in the early part of the examination period. They found that over time, about 25-38% of patients were classified as having improved symptoms, while 5-6% were classified as having worse symptoms. However, after excluding the first few weeks of the examination period, the number of patients classified as improved fell to 15-25%, while the number of patients classified as worsening was slightly higher at 6-9%. Researchers said these findings illustrate the variability of symptoms in CPPS, and in particular, that patients tended to have worse symptoms at enrollment. Thus, they suggested future treatment studies in CPPS might need to include a “run-in” period to account for this phenomenon of early symptom regression.