Widespread pain phenotypes impact treatment efficacy results in randomized clinical trials for interstitial cystitis/bladder pain syndrome: a Multidisciplinary Approach to the Study of Chronic Pelvic Pain network study
Pain clinical trials are notoriously complex and often inefficient in demonstrating efficacy, even for known efficacious treatments. A major issue is the difficulty in the a priori identification of specific phenotypes to include in the study population. Recent work has identified the extent of widespread pain as an important determinant of the likelihood of response to therapy, but it has not been tested in clinical trials for the treatment of interstitial cystitis/bladder pain syndrome (IC/BPS). We explored this hypothesis using data from 3 previously published trials testing treatments for IC/BPS, which suggested modest benefits but did not meet a priori primary outcome statistical significance criteria. Importantly, these studies also collected symptom questionnaire data that allowed us to retrospectively identify participants with and without widespread pain. Analyzing the treatment by the degree of widespread pain revealed a difference in outcome and statistical significance level for each trial. Participants with predominately local pain (ie, limited widespread pain symptoms) responded to therapy targeting local symptoms, whereas those with widespread pain did not. Alternatively, participants with widespread pain beyond their local pelvic pain responded to more centrally acting treatments. Our results suggest that differentiating patients based on widespread vs more localized pain is a key consideration for designing future clinical trials for conditions with variable pain profiles, such as IC/BPS and potentially other pain-based syndromic disorders.
Authors
- James Quentin Clemens (ORCID: https://orcid.org/0000-0002-0759-3385)
- Robert Moldwin (ORCID: https://orcid.org/0000-0002-2603-9160)
- Bruce D. Naliboff (ORCID: https://orcid.org/0000-0003-0959-8670)
- Steven E. Harte (ORCID: https://orcid.org/0000-0002-2929-8694)
- H. Henry Lai (ORCID: https://orcid.org/0000-0003-2691-994X)
- David A. Williams (ORCID: https://orcid.org/0000-0002-5052-4895)
- Bayley J. Taple (ORCID: https://orcid.org/0000-0002-5812-5848)
- Ziya Kırkalı
- Alisa Stevens (ORCID: https://orcid.org/0000-0001-5422-7065)
- James William Griffith (ORCID: https://orcid.org/0000-0002-4840-8692)
- Kenneth Locke
- Larissa V. Rodríguez
- J. Richard Landis (ORCID: https://orcid.org/0000-0001-8099-0988)
- Siobhan Sutcliffe (ORCID: https://orcid.org/0000-0002-4613-8107)
- Karl J. Kreder (ORCID: https://orcid.org/0000-0002-8981-5286)
- Michel A. Pontari (ORCID: https://orcid.org/0000-0002-7369-5435)
- Andrew Schrepf (ORCID: https://orcid.org/0000-0003-4291-0320)
- John T. Farrar (ORCID: https://orcid.org/0000-0001-8656-5157)
- John N. Krieger (ORCID: https://orcid.org/0000-0003-4111-3442)
- Anthony J. Schaeffer (ORCID: https://orcid.org/0000-0002-1324-3517)
- Chris Mullins (ORCID: https://orcid.org/0000-0003-1559-852X)
Institutions
- Northwestern University (US)
- University of Iowa (US)
- National Institutes of Health (US)
- Penn Presbyterian Medical Center (US)
- University of California, Los Angeles (US)
- University of Washington (US)
- Washington University in St. Louis (US)
- Cornell University (US)
- University of Michigan (US)
- National Institute of Diabetes and Digestive and Kidney Diseases (US)
- Neurobehavioral Systems (US)
- Donald & Barbara Zucker School of Medicine at Hofstra/Northwell (US)
- University of Pennsylvania (US)
- Temple University (US)
Publication Details
- Journal
- Pain
- Published
- 2024-11-05
- DOI
- https://doi.org/10.1097/j.pain.0000000000003455
- Citations
- 19
- Primary Topic
- Urinary Bladder and Prostate Research
- Type
- article
- Field-Weighted Citation Impact
- 10.17
Funders
- National Institute of Diabetes and Digestive and Kidney Diseases