Role of CNS in Modulation of Pelvic Pain Syndrome

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As with many chronic pain disorders, Syndromes of Chronic Pelvic Pain (SCPP), which, for the purposes of this proposal, include Urological Syndromes of Chronic Pelvic Pain (UCPPS) [interstitial cystitis (1C), painful bladder syndrome (PBS), chronic prostatitis (CP), chronic pelvic pain syndrome (CPPS)] and a commonly comorbid gastroenterological pain syndrome, Irritable Bowel Syndrome (IBS)] are poorly understood and debilitating disorders for which treatment is mostly empirical and unsatisfactory. In preliminary studies, UCPPS patients exhibited brain atrophy and increased brain activity in the mPFC. These changes in UCPPS are similar-yet-distinct from those seen in Chronic Back Pain (CBP) and are different from acute pain. In addition, differential findings of UCPPS spontaneous pain fluctuations and brain activity, referred pain/hypersensitivity tests, and cognitive tests suggest that UCPPS pain presents a profile distinct from other chronic pain. Similar results have been reported in IBS. Thus, we hypothesize that UCPPS and IBS uniquely impact the brain and that brain markers correlate with clinical parameters of SCPP and are influenced by the location duration and severity of the pelvic pain. To test this hypothesis, we will pursue four aims by characterizing SCPP and age/gendermatched controls in each aim. In Aim 1, brain morphometry will be measured precisely. In Aim 2, local brain activity will be quantified in real time. In Aim 3, cognitive function deficits will be evaluated. And in Aim 4, skin sensitivity will be quantified to assess the specificity of referred pain. Thus, these studies will identify novel brain and cognitive biomarkers of SCPP. These studies will also provide the foundation for targeted pharmacotherapies tailored to SCPP. KEY ABBREVIATIONS SCPP = Syndromes of Chronic Pelvic Pain UCPPS = Urological Chronic Pelvic Pain Syndromes IBS = Irritable Bowel Syndrome CP = Chronic Prostatitis CPPS = Chronic Pelvic Pain Syndrome 1C = Interstitial Cystitis PBS = Painful Bladder Syndrome