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CPPS)
THE JOURNAL OF UROLOGY姞
UNDERSTANDING THE MECHANISTIC ROLE OF PAIN APPRAISALS AND BEHAVIOURAL COPING STRATEGIES BETWEEN PAIN AND QUALITY OF LIFE IN CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME (CP/CPPS) Dean A. Tripp*, J. Curtis Nickel, Adrijana Koljuskov, Kingston, Canada; Daniel Shoskes, Cleveland, OH; Michel Pontari, Philadelphia, PA; Mark S. Litwin, Los Angeles, CA; Mary F. McNaughton-Collins, Boston, MA INTRODUCTION AND OBJECTIVES: Chronic Prostatitis/ Chronic Pelvic Pain Syndrome (CP/CPPS) is characterized by pelvic pain and is largely refractory. Studies have correlated pain, depression, catastrophizing and sedentary behavior on quality of life (QoL) or pain, showing the saliency of psychosocial factors. However, no study has examined a comprehensive list of pain appraisal and behavioural coping strategies as mechanisms in the relationship between pain and QoL. From a self-regulation model, understanding how appraisals and coping interact with outcomes like pain and QoL are important in advancing patient management. METHODS: Men (n⫽168) previously enrolled in the NIH Chronic Prostatitis Cohort study in North American tertiary care centers (6-U.S., 1-Canada) completed a one-time survey of validated selfreport measures (QoL:SF-12; demographics; pain: McGill; behavioural pain coping:CPCI; catastrophizing:PCS; Social Support:MSPSS). Data were examined for normality and missing values. Associations of validated pain appraisals (Catastrophizing) and behavioural coping (Illness-focused coping) with outcomes of pain and QoL were examined. Multivariable mediation models tested mediation roles between pain and QoL. RESULTS: Multivariable mediation analyses for the relationship between pain and physical QoL was run with mediators of IllnessFocused Coping (IF-coping), Wellness-Focused Coping (WF-coping), Social Support and Catastrophizing showing that only IF-coping was a significant mediator of this relationship (⬍.001). Follow-up analyses of subscales for IF-coping (Guarding, Resting, Asking for Assistance, Medication Use) showed Guarding was a unique mediator. Mediation analyses between pain and mental QoL was run with mediators of IF-coping, Social Support and Catastrophizing showing support and catastrophizing were significant mediators (⬍.001). Subscale followups for support (Family, Friends, Significant Other) and Catastrophizing (Rumination, Magnification, Helplessness) showed Friends and Helplessness were unique mediators. CONCLUSIONS: These results suggest that IF-coping, Helpless Catastrophic pain appraisals and Friends act as mechanisms that drive and buffer the negative association between pain and QoL indices. Due to the nature of these associations, the hypothesis that symptoms may be physically and mentally disabling through behavioural, cognitive and environmental mechanisms is supported. Source of Funding: Supported by cooperative agreements from the National Institute of Diabetes and Digestive and Kidney Diseases: U01 DK53752, U01 DK53730, U01 DK53736, U01 DK53734, U01DK53732, U01 DK53746, & U01 DK53738.
Antonella Giannantoni*, Perugia, Italy; Silvia Proietti, Milano, Italy; Marilena Gubbiotti, Jacopo Adolfo Rossi de Vermandois, Massimo Porena, Perugia, Italy INTRODUCTION AND OBJECTIVES: The aetiology of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is poorly understood and treatment is still a frustrating challenge to physicians. Although single or sequential monotherapy treatments represent the most frequently adopted therapies in CP/CPPS, a multimodal approach directed to control different aspects of the diseases should achieve the greatest improvement in clinical symptoms. METHODS: 38 patients affected by CP/CPPS were prospectively included in the study. Patients underwent urinalyses and culture, analysis of prostatic secretion, NHI-CPSI questionnaire, IIEF-5 questionnaire, uroflowmetry and evaluation of psychological status using Hamilton Anxiety Scale (HAM-A) and Hamilton Depression Scale (HAM-D). Patients were randomly assigned to receive a multimodal therapy (Group 1) or conventional monotherapy (Group 2) for 16 wks. Multimodal therapy consisted of a simultaneous administration of oral tamsulosin 0.4 mg/d, oral duloxetine 60 mg/d, saw palmetto 320 mg/d. Monotherapy consisted of tamsulosin 0,4 mg once daily. NHI-CPSI and IIEF-5 questionnaires, uroflowmetry and evaluation of psychological status were repeated at 16 weeks follow up. RESULTS: At 16 wks follow up we observed a significant amelioration in NIH-CPSS total score and sub-scores and significant improvements in HAM-A and HAM-D scores in patients in Group 1. Patients in Group 2 showed a significant improvement in NIH-CPSS total score, in urinary symptoms subscore and in HAM-A total score. (Table 1) We could not detect significant changes in IIEF-5 scores in both Groups of patients between baseline observation and 16 wks follow up. Four patients in Group 1 stopped assuming duloxetine due to adverse effects. CONCLUSIONS: A multimodal therapy including an antidepressant, an alpha-blocker and a saw palmetto extract was superior to a monotherapy with an alpha-blocker drug alone, in controlling clinical symptoms and improving psychological status and QoL in patients affected by CP/CPPS.
Table 1. Primary outcome measures at baseline and 16 weeks in patients with CP/CPPS (multimodal therapy vs monotherapy)
NIH-CPSS pain subscore Mean (SD)
11.9 (3.1)
6.1 (3.3)
⬍0.05 12.3 (3.0)
10.6 (4.2)
0.06
NIH-CPSS Urinary symptoms subscore
4.5 (2.3)
3.8 (2.6)
⬍0.01
4.4 (2.2)
3.4 (2.1)
⬍0.01
NIH-CPSS QoL subscore
8.7 (2.3)
5.8 (3.0)
⬍0.01
8.8 (2.2)
7.4 (4.5)
0.04
Monotherapy 16 weeks mean (SD)
1170
THE EFFICACY AND SAFETY OF A MULTIMODAL THERAPY FOR CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN: A PROSPECTIVE RANDOMIZED STUDY
Monotherapy Baseline mean (SD)
Source of Funding: None
1171
Multimodal therapy 16 weeks mean (SD)
CONCLUSIONS: This is the first study showing that enterococcal IE is statistically associated with preceding urological procedures. The bacteraemia leading to IE may be a result of the urological procedures or a consequence of the underlying urological pathology causing recurrent subclinical bacteraemia(s).
Vol. 189, No. 4S, Supplement, Monday, May 6, 2013
Multimodal therapy Baseline mean (SD)
e478
p
p
NIH-CPPS total score 25.1 (3.7) 14.17 (2.2) ⬍0.01 24.25 (8.4) 20.14 (3.6) ⬍0.05
Source of Funding: None
UNDERSTANDING THE MECHANISTIC ROLE OF PAIN APPRAISALS AND BEHAVIOURAL COPING STRATEGIES BETWEEN PAIN AND QUALITY OF LIFE IN CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME (CP/CPPS) Dean A. Tripp*, J. Curtis Nickel, Adrijana Koljuskov, Kingston, Canada; Daniel Shoskes, Cleveland, OH; Michel Pontari, Philadelphia, PA; Mark S. Litwin, Los Angeles, CA; Mary F. McNaughton-Collins, Boston, MA INTRODUCTION AND OBJECTIVES: Chronic Prostatitis/ Chronic Pelvic Pain Syndrome (CP/CPPS) is characterized by pelvic pain and is largely refractory. Studies have correlated pain, depression, catastrophizing and sedentary behavior on quality of life (QoL) or pain, showing the saliency of psychosocial factors. However, no study has examined a comprehensive list of pain appraisal and behavioural coping strategies as mechanisms in the relationship between pain and QoL. From a self-regulation model, understanding how appraisals and coping interact with outcomes like pain and QoL are important in advancing patient management. METHODS: Men (n⫽168) previously enrolled in the NIH Chronic Prostatitis Cohort study in North American tertiary care centers (6-U.S., 1-Canada) completed a one-time survey of validated selfreport measures (QoL:SF-12; demographics; pain: McGill; behavioural pain coping:CPCI; catastrophizing:PCS; Social Support:MSPSS). Data were examined for normality and missing values. Associations of validated pain appraisals (Catastrophizing) and behavioural coping (Illness-focused coping) with outcomes of pain and QoL were examined. Multivariable mediation models tested mediation roles between pain and QoL. RESULTS: Multivariable mediation analyses for the relationship between pain and physical QoL was run with mediators of IllnessFocused Coping (IF-coping), Wellness-Focused Coping (WF-coping), Social Support and Catastrophizing showing that only IF-coping was a significant mediator of this relationship (⬍.001). Follow-up analyses of subscales for IF-coping (Guarding, Resting, Asking for Assistance, Medication Use) showed Guarding was a unique mediator. Mediation analyses between pain and mental QoL was run with mediators of IF-coping, Social Support and Catastrophizing showing support and catastrophizing were significant mediators (⬍.001). Subscale followups for support (Family, Friends, Significant Other) and Catastrophizing (Rumination, Magnification, Helplessness) showed Friends and Helplessness were unique mediators. CONCLUSIONS: These results suggest that IF-coping, Helpless Catastrophic pain appraisals and Friends act as mechanisms that drive and buffer the negative association between pain and QoL indices. Due to the nature of these associations, the hypothesis that symptoms may be physically and mentally disabling through behavioural, cognitive and environmental mechanisms is supported. Source of Funding: Supported by cooperative agreements from the National Institute of Diabetes and Digestive and Kidney Diseases: U01 DK53752, U01 DK53730, U01 DK53736, U01 DK53734, U01DK53732, U01 DK53746, & U01 DK53738.
Antonella Giannantoni*, Perugia, Italy; Silvia Proietti, Milano, Italy; Marilena Gubbiotti, Jacopo Adolfo Rossi de Vermandois, Massimo Porena, Perugia, Italy INTRODUCTION AND OBJECTIVES: The aetiology of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is poorly understood and treatment is still a frustrating challenge to physicians. Although single or sequential monotherapy treatments represent the most frequently adopted therapies in CP/CPPS, a multimodal approach directed to control different aspects of the diseases should achieve the greatest improvement in clinical symptoms. METHODS: 38 patients affected by CP/CPPS were prospectively included in the study. Patients underwent urinalyses and culture, analysis of prostatic secretion, NHI-CPSI questionnaire, IIEF-5 questionnaire, uroflowmetry and evaluation of psychological status using Hamilton Anxiety Scale (HAM-A) and Hamilton Depression Scale (HAM-D). Patients were randomly assigned to receive a multimodal therapy (Group 1) or conventional monotherapy (Group 2) for 16 wks. Multimodal therapy consisted of a simultaneous administration of oral tamsulosin 0.4 mg/d, oral duloxetine 60 mg/d, saw palmetto 320 mg/d. Monotherapy consisted of tamsulosin 0,4 mg once daily. NHI-CPSI and IIEF-5 questionnaires, uroflowmetry and evaluation of psychological status were repeated at 16 weeks follow up. RESULTS: At 16 wks follow up we observed a significant amelioration in NIH-CPSS total score and sub-scores and significant improvements in HAM-A and HAM-D scores in patients in Group 1. Patients in Group 2 showed a significant improvement in NIH-CPSS total score, in urinary symptoms subscore and in HAM-A total score. (Table 1) We could not detect significant changes in IIEF-5 scores in both Groups of patients between baseline observation and 16 wks follow up. Four patients in Group 1 stopped assuming duloxetine due to adverse effects. CONCLUSIONS: A multimodal therapy including an antidepressant, an alpha-blocker and a saw palmetto extract was superior to a monotherapy with an alpha-blocker drug alone, in controlling clinical symptoms and improving psychological status and QoL in patients affected by CP/CPPS.
Table 1. Primary outcome measures at baseline and 16 weeks in patients with CP/CPPS (multimodal therapy vs monotherapy)
NIH-CPSS pain subscore Mean (SD)
11.9 (3.1)
6.1 (3.3)
⬍0.05 12.3 (3.0)
10.6 (4.2)
0.06
NIH-CPSS Urinary symptoms subscore
4.5 (2.3)
3.8 (2.6)
⬍0.01
4.4 (2.2)
3.4 (2.1)
⬍0.01
NIH-CPSS QoL subscore
8.7 (2.3)
5.8 (3.0)
⬍0.01
8.8 (2.2)
7.4 (4.5)
0.04
Monotherapy 16 weeks mean (SD)
1170
THE EFFICACY AND SAFETY OF A MULTIMODAL THERAPY FOR CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN: A PROSPECTIVE RANDOMIZED STUDY
Monotherapy Baseline mean (SD)
Source of Funding: None
1171
Multimodal therapy 16 weeks mean (SD)
CONCLUSIONS: This is the first study showing that enterococcal IE is statistically associated with preceding urological procedures. The bacteraemia leading to IE may be a result of the urological procedures or a consequence of the underlying urological pathology causing recurrent subclinical bacteraemia(s).
Vol. 189, No. 4S, Supplement, Monday, May 6, 2013
Multimodal therapy Baseline mean (SD)
e478
p
p
NIH-CPPS total score 25.1 (3.7) 14.17 (2.2) ⬍0.01 24.25 (8.4) 20.14 (3.6) ⬍0.05
Source of Funding: None