Protocol Number: 04-CH-0056

Title:

The Neural Immune Mechanisms and Genetic Influences on Chronic Pelvic Pain in Women with Endometriosis

Number:

04-CH-0056

Summary:

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: 1) have endometriosis and chronic pelvic pain, 2) have chronic pelvic pain without endometriosis, and 3) have neither endometriosis nor chronic pelvic pain 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:

1. Medical history and physical examination, including pelvic exam, blood tests, urinalysis, and diaphragm fitting.

2. Questionnaires about pain, quality of life, sexuality, psychological attitudes, spiritual experiences, and history of headache and depression.

3. 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.

4. 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.

-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.

-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.

Sponsoring Institute:

National Institute of Child Health and Human Development (NICHD)

Recruitment Detail

Type: Active Accrual Of New Subjects

Gender: Female

Referral Letter Required: No

Population Exclusion(s): Male

Children

Eligibility Criteria:

INCLUSION CRITERIA:

Women between the ages of 18 and 50 years, who have their reproductive organs.

Excellent health other than a three-month history of pelvic pain and documented endometriosis at laparoscopy. Chronic medications may be acceptable at the discretion of the Principal Investigator (PI). Use of antidepressants, medications for migraines and headaches, allergy medications, and treatment of bowel symptoms such as irritable bowel disease will be allowed.

Do not desire pregnancy for the duration of the study.

Are using abstinence, mechanical (condoms, diaphragms) or sterilization methods of contraception and are willing to continue using them throughout the study.

Willing and able to give informed consent.

Willing and able to comply with study requirements.

BMI less than 32 kg/m(2).

History of regular cyclic menses.

EXCLUSION CRITERIA:

Women with other causes of chronic pelvic pain including infectious, gastrointestinal, psychologic disorders, fibromyalgia and chronic fatigue syndrome.

Significant abnormalities in the physical or laboratory examination including renal and liver function more than twice the normal range.

Hysterectomy or bilateral salpingo-oophorectomy.

Pregnancy.

Lactation.

Use of hormonal contraception, selective estrogen receptor modulators, progestins, estrogens, steroids, or ovulation induction in the last 3 months.

Other medical or surgical treatment for endometriosis in the last 6 months.

Untreated abnormal pap smear or other gynecologic condition.

Manic-depressive illness or untreated major depression.

HIV infection.

Special Instructions: Currently Not Provided

Keywords:

Neuromusculoskeletal Pain

Laparoscopy

Cytokines

HPA Axis

Neuroimmune

Endometriosis

Surgical Excision

Inflammatory Cytokines

Recruitment Keywords:

None

Conditions:

Endometriosis

Pelvic Pain

Investigational Drug(s):

None

Investigational Device(s):

None

Contacts:

Patient Recruitment and Public Liaison Office
Building 61
10 Cloister Court
Bethesda, Maryland 20892-4754
Toll Free: 1-800-411-1222
TTY: 301-594-9774 (local),1-866-411-1010 (toll free)
Fax: 301-480-9793

Electronic Mail:prpl@mail.cc.nih.gov

Citations:

Al-Harthi L, et al. A human immunodeficiency virus (HIV)-inducing factor from the female genital tract activates HIV-1 gene expression through the kappaB enhancer. J Infect Dis. 1998 Nov;178(5):1343-51. PMID: 9780254

Al-Harthi L, et al. The impact of the ovulatory cycle on cytokine production: evaluation of systemic, cervicovaginal, and salivary compartments. J Interferon Cytokine Res. 2000 Aug;20(8):719-24. PMID: 10954915

Berkley KJ. Sex differences in pain. Behav Brain Sci. 1997 Sep;20(3):371-80; discussion 435-513. PMID: 10097000

• Questions about participating in a study, please contact the Patient Recruitment and Public Liaison Office, CC.
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