Pelvic pain classification system: A step in the right direction

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When it comes to etiology and treatment of chronic pelvic pain, one size doesn't fit all.

UPOINT helps us recognize that, when it comes to etiology and treatment of CPP, one size doesn't fit all. The constellation of complaints calls for treatment directed specifically at them. In our practices, we phenotype other conditions we treat, such as prostate cancer, where stage, Gleason score, and other factors determine the treatments we apply. It makes sense to do likewise for urologic CPP. Moreover, treating patients in clinical trials without phenotyping has likely made it difficult to show any efficacy because the population at risk may have had a limited number of patients with the symptoms the therapy targets.

As a symptom-based phenotyping system, UPOINT is a good first step toward what we need. The next step is to build the evidence base by applying the system in rigorous, double-blind, controlled studies to see if directed therapy provides real benefit.

High levels of the chemokines MIP and MCP, which suggest prostatic abnormality, have been associated with some chronic pelvic pain syndrome patients and might fulfill this role. Work to further delineate phenotypes with biological markers, using central nervous system imaging, for example, is one of the goals of the Multidisciplinary Approach to the Study of Chronic Pain (MAPP) Research Network.

The UPOINT system is a step in the right direction, paving the way for better-directed treatment and better-controlled clinical trials. At the same time, it doesn't reduce the need to develop more secure biomarkers and to understand the pathophysiology of the condition so that, ultimately, therapies can be directed at pathophysiology.

Dr. Schaeffer, a member of the Urology Times Editorial Council, is professor and chairman of the department of urology at the Northwestern University Feinberg School of Medicine, Chicago.

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