CHRONIC OVERLAPPING PAIN CONDITIONS IN REFRACTORY UROLOGIC CHRONIC PELVIC PAIN SYNDROME (UCPPS):COMORBIDITY PATTERNS, ILLNESS BURDEN, AND TREATMENT IMPLICATIONS

OBJECTIVE: To examine Chronic Overlapping Pain Conditions (COPC) prevalence in Urologic Chronic Pelvic Pain Syndrome (UCPPS) patients and assess the independent contributions of specific COPCs and pairwise COPC combinations to severity of UCPPS and non-urological symptoms, health-related quality of life (QOL), and psychological distress. METHODS: Cross-sectional baseline data were collected from 152 UCPPS patients (Mage 43 yrs; 83% female) enrolled in an NIH-funded clinical trial. Participants completed validated instruments assessing COPCs as well as severity of UCPPS symptoms; physical and mental QOL; nonurological symptoms; overall pain intensity, distribution, quality and interference in daily life; as well as psychological distress. RESULTS: Patients reported a mean of 1.9 COPCs. Individual COPCs were most consistently associated with broader pain distribution, reduced physical functioning, and greater fatigue; endometriosis demonstrated the most extensive pattern of statistically significant relationships. In analyses of 36 possible COPC dyads, migraine-containing pairs were frequently represented among the top 10 combinations and were linked to greater pain intensity, fatigue, pain interference, and poorer physical functioning. Emotional distress, pain catastrophizing, and UCPPS symptom severity showed weak associations with COPC load across analyses. CONCLUSIONS: COPCs load is substantially associated with greater illness burden in UCPPS, with the most pronounced effects on physical functioning, fatigue, pain distribution, and overall pain intensity. Migraine-containing dyads were associated with the highest illness burden. These findings warrant consideration of brief COPC screening in patients with centralized pain phenotype refractory to peripherally directed therapies.