About MAPP Network

In 2008 the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH) launched the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network. This study represented a novel, highly collaborative and multidisciplinary research effort designed to better understand the underlying pathophysiology and patient “phenotypes” (i.e., observable biological and clinical characteristics) for the two most prominent chronic urologic pain conditions, Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) in women and men and Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) in men.

Explore DataView

The MAPP DataView Dashboard permits exploration and visualization of clinical research data obtained from the MAPP I EPS and MAPP II SPS cohort study participants with UCPPS, and selected control participants.

Featured Publications

Transitions from Regional to Widespread Pain in Urologic Chronic Pelvic Pain Syndrome (UCPPS): A MAPP II Research Network Study

Clemens JQ, Naliboff BD, Bradley CS, Yang CC, Clauw DJ, Williams D, Lai HH, Sutcliffe S, Harte SE, Spitznagle T, Landis JR. J Urol. 2026 Jan 21:101097JU0000000000004943. doi: 10.1097/JU.0000000000004943. Online ahead of print. [PMID: 41564284]

Abstract

Purpose: We utilized prospective data from a well-characterized urologic chronic pelvic pain (UCPPS) cohort (including interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome) to identify transitions between localized pelvic pain (LP) and widespread pain (WP), and characteristics associated with these transitions.

Material and methods: A total of 311 individuals (195 women; 116 men) with UCPPS were recruited from 6 sites and followed for 3 years. Participants completed five weekly "run-in" assessments at baseline, followed by quarterly symptom assessments. Responses on a self-reported body pain map were used to define LP vs WP (>2 non-pelvic body map regions with pain). Multivariable modeling was used to evaluate 74 baseline characteristics related to transitions between LP and WP.

Results: At baseline, 126 participants (41%) reported LP, 13 (10.3%) of whom transitioned to WP. Conversely, 17 of the 66 participants (26%) with WP transitioned to LP at follow-up. Progression from LP to WP was associated with: 1) not living with a partner/spouse, and 2) a higher Somatic Awareness Score on the Complex Multi-System Inventory (CMSI). Conversely, transition from WP to LP was associated with: 3) lower urinary urgency symptoms on the CMSI, and 4) higher frequency of sensation of not emptying bladder completely.

Conclusions: Greater levels of baseline non-painful somatic symptoms were associated with progression to widespread pain, suggesting that high baseline somatic symptoms may predict the development of future pain. Not living with a spouse/partner was also associated with progression to widespread pain, highlighting the importance of social support in UCPPS.

Keywords: chronic prostatitis/chronic pelvic pain syndrome; interstitial cystitis/bladder pain syndrome; pelvic pain; prostate; urinary bladder.

Brain predicted age in chronic pelvic pain: a study by the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network.

Leech KA, Kettlety SA, Mack WJ, Kreder KJ, Schrepf A, Kutch JJ. Pain. 2025 May 1;166(5):1060-1069. doi: 10.1097/j.pain.0000000000003424. Epub 2024 Oct 16. [PMID: 39432808]; [PMC12404608]

Abstract

The effect of chronic pain on brain-predicted age is unclear. We performed secondary analyses of a large cross-sectional and 3-year longitudinal data set from the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network to test the hypothesis that chronic pelvic pain accelerates brain aging and brain aging rate. Brain-predicted ages of 492 chronic pelvic pain patients and 72 controls were determined from T1-weighted MRI scans and used to calculate the brain-predicted age gap estimation (brainAGE; brain-predicted - chronological age). Separate regression models determined whether the presence of chronic pelvic pain could explain brainAGE and brain aging rate when accounting for covariates. We performed secondary analyses to understand whether brainAGE was associated with factors that subtype chronic pelvic pain patients (inflammation, widespread pain, and psychological comorbidities). We found a significant association between chronic pelvic pain and brainAGE that differed by sex. Women with chronic pelvic pain had higher brainAGE than female controls, whereas men with chronic pelvic pain exhibited lower brainAGE than male controls on average-however, the effect was not statistically significant in men or women when considered independently. Secondary analyses demonstrated preliminary evidence of an association between inflammatory load and brainAGE. Further studies of brainAGE and inflammatory load are warranted.

Keywords: Chronic pain; Pelvic pain; Brain age; Structural MRI; Inflammation

Trial registration: ClinicalTrials.gov NCT02514265.

Widespread Pain Phenotypes Impact Treatment Efficacy Results in Randomized Clinical Trials for Interstitial Cystitis/Bladder Pain Syndrome: A MAPP Network Study.

Farrar JT, Locke KT Jr., Clemens JQ, Griffith JW, Harte SE, Kirkali Z, Kreder KJ, Krieger JN, Lai HH, Moldwin RM, Mullins C, Naliboff BD, Pontari MA, Rodriguez LV, Schaeffer AJ, Schrepf A, Stephens-Shields A, Sutcliffe S, Taple BJ, Williams DA, Landis JR.  Pain. 2025 May 1;166(5):1179-1190. doi: 10.1097/j.pain.0000000000003455. Epub 2025 Feb 18. [PMID: 39499552]; [PMC12004979]

Abstract

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.

Keywords: Pelvic pain; Widespread pain; Reanalysis of clinical trial results; Pain measurement; Interstitial cystitis

Ecological Momentary Assessment of Pelvic Pain and Urinary Urgency Variability in Urologic Chronic Pelvic Pain Syndrome and Their Association with Illness Impact and Quality of Life: Findings from the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Symptom Patterns Study.

Erickson BA, Griffith JW, Wensheng G, Mengying Y, Herman T, Bradley CS, Quentin Clemens J, Farrar JT, Gupta P, Kreder KJ, Henry Lai H, Naliboff BD, Newman DK, Rodriguez LV, Spitznagle T, Sutcliffe S, Sutherland SE, Taple BJ, Richard Landis J.  Neurourol Urodyn. 2024 Apr;43(4):893-901. doi: 10.1002/nau.25363. Epub 2024 Jan 22. [PMID: 38247366] [PMC11031348]

Abstract

Purpose: This study tested the hypothesis that ecological momentary assessment (EMA) of pelvic pain (PP) and urinary urgency (UU) would reveal unique Urologic Chronic Pelvic Pain Syndrome (UCPPS) phenotypes that would be associated with disease specific quality of life (QOL) and illness impact metrics (IIM).

Materials and methods: A previously validated smart phone app (M-app) was provided to willing Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) participants. M-app notifications were sent 4-times daily for 14 days inquiring about PP and UU severity. A clustering algorithm that accounted for variance placed participants into PP and UU variability? clusters. Associations between clusters and QOL and IIM were then determined.

Results: A total of 204 participants enrolled in the M-app study (64% female). M-app compliance was high (median 63% of surveys). Cluster analysis revealed k = 3 (high, low, none) PP clusters and k = 2 (high, low) UU clusters. When adjusting for baseline pain severity, high PP variability, but not UU variability, was strongly associated with QOL and IIM; specifically worse mood, worse sleep and higher anxiety. UU and PP clusters were associated with each other (p < 0.0001), but a large percentage (33%) of patients with high PP variability had low UU variability.

Conclusions: PP variability is an independent predictor of worse QOL and more severe IIM in UCPPS participants after controlling for baseline pain severity and UU. These findings suggest alternative pain indices, such as pain variability and unpredictability, may be useful adjuncts to traditional measures of worst and average pain when assessing UCPPS treatment responses.

Keywords: ecological momentary assessment; illness impact; phone application; quality of life; urologic chronic pelvic pain syndrome; variability.

Validation of a simple body map to measure widespread pain in urologic chronic pelvic pain syndrome: A MAPP research network study.

Clemens JQ, Locke K Jr, Landis JR, Kreder K, Rodriguez LV, Yang CC, Tu FF, Harte SE, Schrepf A, Farrar JT, Sutcliffe S, Naliboff BD, Williams DA, Afari N, Spitznagle T, Taple BJ, Lai HH; Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network.  Neurourol Urodyn. 2024 Mar;43(3):727-737. doi: 10.1002/nau.25400. Epub 2024 Jan 25. [PMID: 38270336] [PMC10981467]

Abstract

Purpose: In patients with urologic chronic pelvic pain syndrome (UCPPS), the presence of widespread pain appears to identify a distinct phenotype, with a different symptom trajectory and potentially different response to treatment than patients with pelvic pain only.

Materials and methods: A 76-site body map was administered four times, at weekly intervals, to 568 male and female UCPPS participants in the MAPP Network protocol. The 76 sites were classified into 13 regions (1 pelvic region and 12 nonpelvic regions). The degree of widespread pain was scored from 0 to 12 based on the number of reported nonpelvic pain regions. This continuous body map score was regressed over other measures of widespread pain, with UCPPS symptom severity, and with psychosocial variables to measure level of association. These models were repeated using an updated body map score (0-12) that incorporated a threshold of pain ≥ 4 at each site.

Results: Body map scores showed limited variability over the 4 weekly assessments, indicating that a single baseline assessment was sufficient. The widespread pain score correlated highly with other measures of widespread pain and correlated with worsened UCPPS symptom severity and psychosocial functioning. Incorporating a pain severity threshold ≥4 resulted in only marginal increases in these correlations.

Conclusions: These results support the use of this 13-region body map in the baseline clinical assessment of UCPPS patients. It provides reliable data about the presence of widespread pain and does not require measurement of pain severity, making it relatively simple to use for clinical purposes.

Keywords: chronic prostatitis/chronic pelvic pain syndrome; interstitial cystitis/bladder pain syndrome; pelvic pain; prostate; urinary bladder.