Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

For adult female patients, what is the comparative effective of non-surgical and surgical treatment of chronic pelvic pain?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Drugs, behavioral treatments and hysterectomy (with or without oophorectomy)

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Females between the ages of 25-65 with chronic pelvic pain presumably due to adenomyosis, endometriosis or underlying etiology not-specified

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Improvement in patient symptoms, function (including sexual function) and satisfaction.

Describe any health-related risks, side effects, or harms that you are concerned about.

If surgery is performed (hysterectomy), risk of complications and death. If medications, include side effects. Also concern involves persistence of chronic pain post-surgery and poassible predictors of poor outcomes to improve patient selection.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Pregnancy, including preterm birth

AHRQ Priority Populations

• Women

Federal Health Care Program

None

Importance

Describe why this topic is important.

Hysterectomy for pelvic pain is particularly common. Often the reasons given include: cessation of childbirth, debilitating pain despite hormonal treatment, inability to take hormonal treatments due to age, tobacco use, etc.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

As a health plan medical director commercial and Medicaid populations, this is a common dilemma. There is very little guidance from traditional sources (ACOG, etc) that is evidence-based.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

See anser to Q9. What constitutes appropriate clinical care is at the heart of this and what guidance clinicians can give to patients would be of immense benefit.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

See Q9. If in fact, the evidence points to one approach or another or some step-wise combination of the two, this would be of benefit to a wide number of constituencies include patients, clinicians and policy makers.

Describe the timeframe in which an answer to your question is needed.

This is an ongoing issue. I see no true urgency in addressing this.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

See Q9. If in fact, the evidence points to one approach or another or some step-wise combination of the two, this would be of benefit to a wide number of constituencies include patients, clinicians and policy makers.

Are you making a suggestion as an individual or on behalf of an organization?

Individual

Please tell us how you heard about the Effective Health Care Program