A BRIEF, TRANSDIAGNOSTIC COGNITIVE BEHAVIORAL TREATMENT FOR UROLOGIC CHRONIC PELVIC PAIN SYNDROME (UCPPS): PROCESS, PREDICTIONS, OUTCOMES - Abstract/Project Summary
Urologic chronic pelvic pain syndrome (UCPPS) encompasses several common, costly diagnoses including
interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome that are poorly
understood and inadequately treated. Their prolonged personal and economic costs are amplified by the
frequent co-occurrence of a cluster of centralized pain conditions (particularly irritable bowel syndrome 3 [IBS])
but also fibromyalgia [FMS], chronic headache, chronic fatigue, etc.) called Chronic Overlapping Pain Conditions
(COPC). Clinically, the notion that these syndromes share a centralized pain phenotype with a fundamental
disturbance in pain or sensory processing dovetails with our preliminary research showing that a novel
transdiagnostic behavioral treatment emphasizing a single common mechanistic pathway (i.e. inflexible cognitive
style) reduces severity of both targeted (IBS) and untargeted multisymptom COPCs that include (but is not limited
to) to UCPPS, FMS, chronic fatigue, and chronic headache. If effective in a larger scale study, a transdiagnostic
UCPPS treatment would offer a more efficient, accessible, and broadly useful strategy for improving chronic
pelvic pain and its most frequent and complicating comorbidities. To this end, we will randomize 240 UCPPS
subjects (18-70 yrs.) of any gender and race to a 4-session version of CBT that teaches skills for self-managing
UCPPS symptoms (e.g. pelvic pain, urinary symptoms) with minimal clinician oversight (MC-CBT) or a four-
session non-specific education/support control (EDU). Efficacy assessments will be administered at pre-
treatment and two weeks after the end of the 10-week acute phase. We hypothesize MC-CBT will deliver
significantly greater UCPPS symptom improvement than EDU (Aim 1). Additional aims include characterizing
the durability of effects 3- and 6 months post treatment (Aim 2). To increase the efficacy and efficiency of
behavioral pain treatments, we draw upon Beck’s transdiagnostic cognitive model13 to characterize the precise
cognitive procedures and corresponding operative processes (e.g., cognitive distancing14, context sensitivity,
coping flexibility, repetitive negative thought) that drive MC-CBT induced UCPPS symptom relief relative to EDU
(Aim 3) as well as baseline patient variables that moderate differential response (Aim 3) with the ultimate goal of
more proactive patient-treatment matching fundamental to the goals of personalized medicine. By applying
innovative statistical modelling (e.g. dominance analysis, Randomized Explanatory Trial analyses) to study aims
in the context of a rigorously designed behavioral trial, we expand the portfolio of nondrug pain treatments for
UCPPS and co-aggregating COPCs to include one whose brevity, convenience, and transdiagnostic design
“meets patients where they are”20 and addresses the practical (access, complexity, cost), clinical (breadth,
durability, magnitude of effects, patient preference) and conceptual (untargeted comorbidities, non-pain somatic
symptoms) challenges that have impeded uptake and public health impact of evidence-based behavioral pain
treatments at a time when our most vulnerable high impact pain patients are in greatest need.
