Pelvic Pain in Women With Endometriosis
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|ClinicalTrials.gov Identifier: NCT00073801|
Recruitment Status : Completed
First Posted : December 9, 2003
Last Update Posted : March 1, 2021
This study will examine pelvic pain associated with endometriosis and explore better approaches to treatment. In women with endometriosis, uterine tissue grows outside the uterus. Standard treatments - altering hormone levels to prevent endometrial tissue growth or surgically removing endometrial tissue - treat pelvic pain only temporarily. This study will investigate the role of sex hormones, immune chemicals, stress hormones, and genes in pelvic pain and determine how the nerve, muscle, and skeletal systems are involved in this pain.
Women between 18 and 50 years of age who:
- have endometriosis and chronic pelvic pain, and
- have chronic pelvic pain without endometriosis, and
- have neither endometriosis nor chronic pelvic pain and are willing to have a tubal ligation (Healthy Volunteer group),
may be eligible for this study. Candidates are screened with a questionnaire to obtain information about their pain and previous treatments and related medical or social issues. Participants will undergo the following tests and procedures:
- Medical history and physical examination, including pelvic exam, blood tests, urinalysis, and diaphragm fitting.
- Questionnaires about pain, quality of life, sexuality, psychological attitudes, spiritual experiences, and history of headache and depression.
- At-home monitoring for 4 to 6 weeks of pain symptoms, menstruation and spotting, medicines taken, and urine collections to test for "LH" surge. LH is the hormone that causes the ovary to release a mature egg.
Pre-laparoscopy evaluation to include:
- Examination of menstrual blood collected in a diaphragm for 4 hours.
- Blood sampling to measure adrenal and pituitary hormones. For this test, corticotrophin-releasing hormone (CRH) is injected through an IV needle. Up to five blood samples are drawn, starting before the injection until 45 minutes after it. Blood is also collected at this time for genetic analysis.
- In-depth pain assessment to identify trigger points in muscles associated with pelvic pain, regions of skin sensitivity, and bone pain. Some women will undergo microdialysis, which uses an acupuncture-type needle to collect chemicals from two different muscles.
- Blood sampling twice a week for 1 month to measure changes in blood substances during the menstrual cycle.
- Blood sampling after the LH surge to measure progesterone levels.
- Cervicovaginal lavage (washing of the cervix with saline and collecting the fluid) to obtain secretions for research.
- Ultrasound of the ovaries and uterus. This examination uses a probe inserted into the vagina that emits sound waves that are used to form pictures of the internal structures. A small piece of uterine lining is also obtained for examination and research purposes.
- A visit with the members of the Pain and Palliative care service to evaluate the pain in anticipation of offering other treatments for pain after surgery.
CPP + Endo or CPP only: Laparoscopy to look for and remove endometrial tissue. This procedure is done under general anesthetic. A viewing instrument called a laparoscope is passed through an incision in the belly button to look for endometriosis. If it is found, two or more incisions are made in the abdomen for other instruments to remove the tissue. A small piece of uterine lining is also obtained for examination and research purposes.
Healthy Volunteers: Laparoscopy to perform the tubal ligation. A tubal ligation, commonly known as "getting your tubes tied," is a surgical procedure for women to sterilize them. This procedure closes the fallopian tubes, stopping the egg from traveling from the ovary to the uterus and preventing sperm from reaching the fallopian tube to fertilize an egg. In a tubal ligation, fallopian tubes are cut, burned, or blocked with rings, bands or clips. The surgery is effective immediately. Tubal ligations are 99.5% effective as birth control. This procedure is done under general anesthetic. A viewing instrument called a laparoscope is passed through an incision in the belly button to perform a tubal ligation. Two or more incisions are made in the abdomen for other instruments to perform the procedure. During the laparoscopy, we will look for and remove endometrial tissue. A small piece of uterine lining is also obtained for examination and research purposes.
-Follow-up evaluations. Two weeks after surgery, patients return to NIH to discuss the surgical findings and treatment options. Follow-up visits are then scheduled at 1, 3, and 6 months after surgery to complete questionnaires and determine if the treatment is working. Blood samples are drawn at each visit.
|Condition or disease|
|Endometriosis Chronic Pelvic Pain|
|Study Type :||Observational|
|Actual Enrollment :||78 participants|
|Official Title:||The Neural Immune Mechanisms and Genetic Influences on Chronic Pelvic Pain in Women With Endometriosis|
|Study Start Date :||December 8, 2003|
Chronic Pelvic Pain and Endometriosis
Women with chronic pelvic pain and endometriosis found at study surgery
Chronic Pelvic Pain and No Endometriosis
Women with chronic pelvic pain and NO endometriosis found at study surgery
Women without no chronic pelvic pain and no symptoms of endometriosis
- To evaluate the menstrual dynamics of systemic cytokine expression in endometriosis, and to measure the expression of pro-inflammatory cytokines, stem cells, immunologic activity, and neurotransmittors in endometriosis lesions and the endometriu... [ Time Frame: Day 1-3 of the menstrual cycle; by twice weekly blood draws between 8 and 9 AM (14 ml/time) over a four-week period; Mid-luteal cervical secretions and endometrium ]menstrual effluent by collecting menses over a four- hour period on day one to three of the menstrual cycle; Menstrual cycle variation in systemic secretion of inflammatory mediators (IL-6) and hormones, estradiol and progesterone;Mid-luteal cervical secretions and endometrium for measurement of pro and anti-inflammatory effectors
- To evaluate the relation between chronic pelvic pain and the HPA axis in women [ Time Frame: Follicular phase of the menstrual cycle ]CRH stimulation testing. The HPA assessments will include the measurement of morning levels of serum ACTH and cortisol and the serum levels of ACTH and cortisol after CRH stimulation test.
- To evaluate whether routine Pain and Palliative Care services of medication adjustment, psychosocial and spiritual counseling, and mind- body techniques offered post- operatively contribute to relief from pain [ Time Frame: post-operative over six months ]analysis of records from Pain and Palliative care
- To investigate the influence of genetic polymorphisms in pain pathways, pro-inflammatory cytokines, and mediators of sensitization on chronic musculoskeletal pain in women. [ Time Frame: preoperative evaluation ]linkage association and with haplotype mapping genomic on DNA that was freshly isolated and stored at 70 degrees C
- to quantitatively and qualitatively characterize the musculoskeletal components of chronic pelvic pain associated with endometriosis by a standardized neuromusculo-skeletal evaluation. [ Time Frame: Follicular phase of the menstrual Cycle ]Identification of myofascial trigger points in muscles associated with pelvic pain and use pressure algometry to measure pressure pain threshold (the minimal pressure that causes pain; Identification of regions of cutaneous allodynia using Semmes-Weinstein monofilaments across abdominal and pelvic dermatomes. Identification of regions of cutaneous hyperalgesia with a Wartenberg pinwheel across abdominal and pelvic dermatomes. Identification of regions of periosteal tenderness using pressure algometry over bony prominences.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00073801
|United States, Maryland|
|National Institutes of Health Clinical Center, 9000 Rockville Pike|
|Bethesda, Maryland, United States, 20892|
|Principal Investigator:||Barbara I Karp, M.D.||National Institute of Neurological Disorders and Stroke (NINDS)|