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A third group have systematic or widespread symptoms characterized by the presence of widespread pain 26 (significant non-urologic pain outside the pelvis), COPC (e.g., fibromyalgia, IBS), 25 widespread psychosocial difficulties (e.g., anxiety, depression, higher levels of current and lifetime stress, early life and adult traumatic events, negative affect, poor illness coping), 36 or poly-symptomatic, poly-syndromic(PSPS) presentation with widespread somatic symptoms across multiple organ systems