Biopsychosocial factors may help target CP/CPPS treatment

September 1, 2007

Several novel biopsychosocial factors have been identified as significant independent predictors of lower quality of life in patients with chronic prostatitis/chronic pelvic pain syndrome, according to an analysis of data collected from men enrolled in the National Institutes of Health's Chronic Prostatitis Cohort Study.

"This study examines the biopsychosocial factors associated with poorer QoL in men suffering with CP/CPPS, and is important because continuing prevalence research reports prostatitis to range from approximately 6% to greater than 20% across a wide age range, depending on the sample studied," said NIH CPCS co-investigator Dean A. Tripp, PhD, associate professor in the departments of psychology, anesthesiology, and urology, Queen's University, Kingston, Ontario, Canada.

"In previous analyses, we found that poorer QoL was associated with greater urinary scores, depressive symptoms, and pain, but this new study was the first to examine a wider range of both cognitive and environmental factors. Understanding of the variables associated with poorer QoL in men suffering from CP/CPPS will enable the development of a specific, empirically guided symptom management program for individuals who are refractory to standard medical therapies."

"As a plan B, we are trying to identify parameters predicting quality of life," Dr. Nickel, professor of urology at Queen's University, told Urology Times.

"We are now planning to use this collective information to develop a psychosocial cognitive-behavioral-based treatment program aimed primarily to improve quality of life and secondarily to decrease disability. Our hope is that, over time, such an approach can improve the pain these patients suffer, or at least their perception of pain," he added.

The study included 253 men enrolled at the one Canadian and six United States tertiary care clinical sites participating in the NIH CPCS. All of these men were administered a one-time survey, using a number of validated instruments to collect self-reported information on quality of life, demographics, urinary symptoms, depression, current pain, pain coping, catastrophizing, pain control, social support, and solicitous responses from a partner.

Wide-ranging predictors

A multivariate regression model was used to adjust for covariates and to identify independent predictors from among the various biopsychosocial factors of lower scores (poorer QoL) on the Physical Component and Mental Component quality of life subscales of the Short Form 12 (SF12-PCS and SF12-MCS, respectively).

For the SF12-PCS, a poorer score was predicted by worse urinary function (p=.0002) and increased use of pain-contingent resting (p=.026) as a coping strategy. In analysis of SF12-MCS scores, a lower score was predicted by greater pain catastrophizing (p=.002) and lower perceptions of social support (p<.0001).

Further analyses of the subscales from the catastrophizing questionnaire identified a feeling of helplessness (p=.0004) as a significant predictor of poorer mental QoL, while there was no association with the rumination or magnification subscales.

The Multidimensional Scale of Perceived Social Support was used to examine social support. Further analysis of its subscales showed support from family (p=.002) and friends (p=.0002) were the significant predictors, while support from a significant other showed a trend toward significance.

"This new research suggests that, despite pain and urinary symptoms, these predictive parameters could prove to be useful targets to improve QoL for men trying to manage CP/CPPS," Dr. Tripp said. "A pilot study examining a CP/CPPS symptom management program that attacks these psychological symptoms in hope of improving QoL in spite of existing pain is currently under way in our department of urology."