Interactive Mechanisms of Pelvic Pain

骨盆疼痛综合征会导致严重的骨盆疼痛和发病率，并影响家庭和经济。患有泌尿系统慢性盆腔疼痛综合征（UCPPS）的患者通常患有并发症，如肠易激综合征（IBS）。慢性盆腔疼痛的有效治疗因不精确的临床诊断和对这些疾病（单独或作为全身性疾病）的不完全机制理解而变得复杂。因此，我们对MAPP建议的中心假设是，对明确定义的患者群体的诊断和对盆腔疼痛机制的理解的改善将导致治疗的改善。 MAPP倡议将在患者表型、流行病学和基础科学水平的共病背景下检查UCPPS。在其他慢性病症中，慢性疼痛可由外周损伤引起。神经机制可以导致持续的疼痛，即使在初始损伤解决后，但目前还不清楚UCPPS是否会引起类似的变化。我们将应用最先进的疼痛方法来表征盆腔疼痛状况。由于UCPPS和IBS有许多相似之处，包括重叠的疼痛定位和排尿功能障碍，我们将重点关注UCPPS和IBS，并将这些疾病统称为慢性盆腔疼痛综合征（SCPP）。 我们将在三个创新和协同项目中研究SCPP的机制。在项目I中，我们通过表征脑形态/活动和认知功能来鉴定SCPP的新型脑生物标志物。在项目II中，我们将利用NIH路线图计划PROMIS来确定大型队列中SCPP的患病率。最后，在项目III中，我们在SCPP小鼠模型中剖析了盆腔器官串扰和脊髓整合介导共病和持续疼痛的机制。通过专注于膀胱，前列腺和肠道，我们的研究将同样受益于消化系统疾病和肾脏/泌尿系统疾病，NIDDK的双重使命，并为SCPP的靶向治疗提供关键基础。 关键缩略语 SCPP =慢性骨盆疼痛综合征 UCPPS =泌尿系统慢性骨盆疼痛综合征 IBS =肠易激综合征 CP =慢性前列腺炎

Pelvic pain syndromes cause severe pelvic pain and morbidity and impact families and the economy. Patients with urologic chronic pelvic pain syndromes (UCPPS) often suffer co-morbid conditions, such as irritable bowel syndrome (IBS). Effective treatment of chronic pelvic pain is complicated by imprecise clinical diagnoses and incomplete mechanistic understanding of these diseases, individually or as systemic conditions. Thus, our central hypothesis for this MAPP proposal is that improved diagnoses of well-defined patient groups and understanding of pelvic pain mechanisms will lead to improved therapies. The MAPP initiative will examine UCPPS within the context of co-morbidities at the levels of patient phenotype, epidemiology, and basic science. In other chronic conditions, chronic pain can be induced by a peripheral insult. Neural mechanisms can result in sustained pain even after the initiating insult is resolved, but it is unknown whether UCPPS causes similar changes. We will apply state-of-the-art pain methodologies to characterization of pelvic pain conditions. Because UCPPS and IBS share many similarities, including overlapping pain localization and voiding dysfunction, we will focus on UCPPS and IBS and will regard these conditions collectively as syndromes of chronic pelvic pain (SCPP). We will study mechanisms of SCPP in three innovative and synergistic projects. In Project I, we identify novel brain biomarkers of SCPP by characterizing brain morphometry/activity and cognitive function. In Project II, we will exploit the NIH Roadmap initiative PROMIS to determine the prevalence of SCPP in a large cohort. Finally, in Project III, we dissect pelvic organ crosstalk and spinal cord integration mechanisms that mediate co-morbidities and sustained pain in SCPP murine models. By focusing on the bladder, prostate, and bowel, our studies will benefit equally digestive disease and kidney/urologic disease, the dual missions of NIDDK, and provide the critical foundation for targeted therapies for SCPP. KEY ABBREVIATIONS SCPP = Syndromes of Chronic Pelvic Pain UCPPS = Urological Chronic Pelvic Pain Syndromes IBS = Irritable Bowel Syndrome CP = Chronic Prostatitis