Pelvic Pain Research Activities and Advances

Research both directly and indirectly related to pelvic pain is supported through the Gynecological Health and Disease Branch (GHDB) in the Division of Extramural Research.

These studies range from the genetics and molecular biology of pain-related disorders to clinical trials seeking to identify optimal treatment modalities. Specific research receiving grant support includes studies in dysmenorrhea, uterine fibroids, pelvic floor disorders, and vulvodynia. Research support is also provided to clarify mechanistic distinctions in pelvic pain subtypes as well as both peripheral and central pain mechanisms in pelvic pain and vulvodynia. Current studies include:

Central Pain Mechanisms in Primary Dysmenorrhea (PD)

This study aims to better understand the potential role of central pain mechanisms, including excitatory and inhibitory pain responses, in dysmenorrhea. This study is the first of its kind to explore pain responses in PD across the developmental spectrum, which has the potential to identify girls and women at risk for the development of additional chronic pain problems.

Neurophysiological Diagnostics for Menstrual Pain

This study will examine whether involuntary muscle movements/reflexes can be measured to evaluate the pain experienced by women with different types of pelvic pain. The study will compare these muscle movements in women with primary dysmenorrhea and women with chronic pelvic pain in order to determine which nerve pathways are responsible for the pain experienced and to potentially identify targets for treatment.

Mechanistic Distinctions in Female Chronic Pelvic Pain Subtypes

Currently, each pelvic pain subtype is studied in isolation rather than as a system, making patient diagnoses poorly understood. This study examines the many factors (neural/sensory, musculoskeletal, and psychosocial) involved in women with postpartum chronic pelvic pain (CPP) and chronic bladder pain compared to women without CPP. The public health impact of the proposed work will be to enable clinicians to provide more accurate CPP diagnoses and more timely and targeted interventions to improve the quality of life in women with CPP.

The Institute also led efforts to create the NIH Research Plan on Vulvodynia (PDF - 746 KB), which lays out a scientific agenda for the NIH to conduct and gather rigorous scientific evidence needed to answer questions and fill in knowledge gaps about vulvodynia, a primary symptom of which is pelvic pain.

Pelvic pain often has more than one cause, and this complexity is the reason why NICHD collaborates with other NIH Institutes and pain research groups. Specifically:

NICHD conducts and supports a range of research activities to learn more about causes, risk factors, and treatments for endometriosis. The Endometriosis and Women’s Health fact sheet describes the institute’s support of research on this common gynecologic condition and highlights some recent findings and advances from NICHD-funded projects.

NICHD is an active member of the NIH Pain Consortium, which was established to enhance pain research and promote collaboration among researchers across the many NIH Institutes and Centers that have programs and activities addressing pain.

The institute also participates in the NIH Helping to End Addiction Long-term® (HEAL) Initiative, which includes two research areas related to pain and pain management. NICHD leads the HEAL KIDS (Knowledge, Innovation, and Discovery Studies) Pain Network, which studies acute pain in pediatric populations.

In 2013, the World Endometriosis Society Montpellier Consortium published the first-ever worldwide consensus statement on the management of endometriosis. The statement, published in the journal Human Reproduction, addresses 69 issues related to the management of endometriosis. NICHD scientists and grantees were among those on the Consortium. Visit Global Consortium Identifies Best Management of Endometriosis for more information.