Overview

In a recently published comparative effectiveness review (CER) of therapies for noncyclic chronic pelvic pain (CPP), several research gaps within the CPP evidence base were identified. The purpose of this report is to present recommendations for future research on CPP based on the findings from that review and input from stakeholders. We describe a preliminary but reproducible process that relied upon stakeholder engagement and feedback across prespecified criteria to transform identified research gaps into prioritized research needs. CPP in women is a commonly occurring and poorly understood condition. Little consensus on the definition of the condition exists-the duration of pelvic pain considered chronic in published studies varies from 3 to more than 6 months, and the location and pathology of the pain are largely unspecified. The American College of Obstetricians and Gynecologists defines chronic pelvic pain as noncyclical pain of at least 6 months' duration that appears in locations such as the pelvis, anterior abdominal wall, lower back, or buttocks, and that is serious enough to cause disability or lead to medical care. Noncyclic CPP excludes chronic pelvic pain that is limited to dysmenorrhea (pain with menstruation), or dyspareunia (pain with intercourse), dyschezia (pain with bowel movement), or dysuria (pain with urination). Mixed CPP refers to the combination of noncyclic CPP and another pelvic pain that is cyclic or associated with intercourse, bowel movement, or urination. CPP as described throughout this report refers to noncyclic or mixed cyclic/noncyclic pelvic pain unless otherwise noted. Little is known about treating women with CPP and that care is highly variable. Hysterectomy is common treatment option for pelvic pain, but little evidence exists to guide treatment decisions. In 2011, the Vanderbilt Evidence-based Practice Center completed an Agency for Healthcare Research and Quality (AHRQ)-funded systematic review of therapies for women with noncyclic CPP. Despite a prevalence for CPP rivaling that of widely studied conditions such as asthma, little research assessing therapies exists. While there are many publications regarding pelvic pain, there are relatively few addressing noncyclic CPP, and of those, few provide high-quality evidence creating significant gaps in the research literature for treatment of women with noncyclic CPP.

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