Controversial pain op tested

Women with pelvic pain often do not know the cause

Doctors are to study a radical treatment for pelvic pain.

Under keyhole surgery, a nerve which sends pain messages to the brain is severed.

But the procedure is controversial because doctors are divided over whether or not it works.

Many women suffer pain in the lower abdomen and pelvis, caused by periods, endometriosis, internal scarring or infection.

If the results of the trial are positive then women suffering from this common and difficult to treat condition will benefit

Dr Khalid Khan, Birmingham Women's Hospital

But in about half of cases, the cause of the pain can not be identified and how to treat the problem may not be obvious.

One study has estimated pelvic pain affects as many women as migraine, back pain or asthma.

Now Birmingham Clinical Trials Unit and Birmingham Women's Hospital are co-ordinating a national study which hopes to give a definitive answer as to whether the nerve treatment works.

Reducing pain

The procedure is called laparoscopic utero-sacral nerve ablation (Luna).

Nerves are cut using a small needle point electric current or laser.

It is already being used to treat women, but the study will look at how successful it is at alleviating pain and improving quality of life and sexual function.

The study, led by Dr Khalid Khan, a consultant obstetrician and gynaecologist at Birmingham Women's Hospital, has already recruited 100 of the 400 women it eventually hopes to monitor.

It was as if someone had got a metal glove on, pulling my insides out

Tracie Cox

They will already have been sent for hospital treatment for their problem.

Doctors will ask them to fill in a questionnaire to assess their pain and how it affects their life.

They will be asked to complete the same questionnaire three, six, 12, 24 and 36 months after the surgery to see if there has been any improvement.

The study, funded by the women's health charity WellBeing, will randomly allocate women to either have a basic invasive investigation used to diagnose the problem - or an investigation plus surgery.

Because the procedures will be carried out at the same time, women will not know which group they fall in to - so their responses afterwards will not be influenced.

Guidance

Dr Khan told BBC News Online he hoped the study would give an answer for whether or not the operation should be generally introduced to help women with pelvic pain - which doctors currently do not agree on.

"The controversy is reflected in clinical practice. At this time, gynaecologists will look after people with pelvic pain in different ways."

He said women who were involved in the study, including those with period pain, would be those for whom all the usual treatments for such complaints, from chemists or GPs, had failed.

"This study will answer many of the unknowns about Luna. It could promote this operation which is quick, easy and relatively inexpensive; or it might eliminate it.

"If the results of the trial are positive then women suffering from this common, and difficult to treat, condition will benefit.

"If the results are negative then a reliable basis for discouraging the spread of this technique will have been provided."

Suicide

Tracie Cox, from Birmingham, who took part in the Luna study, suffered such bad pelvic pain that she was often doubled up.

"On a couple of occasions, it knocked me off my feet.

"I almost committed suicide, unintentionally, a couple of times, because I was taking so many painkillers."

"It was as if someone had got a metal glove on, pulling my insides out."

Mrs Cox, who has three children, had a hysterectomy last year, since when her pain has been relieved.

She does not yet know if she had the Luna procedure, but said she felt no better after her laparoscopy.

Mr William Stones, secretary of the International Pelvic Pain Society and a consultant gynaecologist at the Princess Anne Hospital in Southampton said: "It's extremely valuable to test treatments, particularly surgical treatments.

"It is something that is very difficult to do.

"And if the study shows it doesn't work, that will be just as helpful as a positive result because it will protect women from inappropriate interventions and unreal expectations."