Comparative Effectiveness Review Number 41 Noncyclic Chronic Pelvic Pain Therapies for Women: Comparative Effectiveness Comparative Effectiveness Review Number 41 Noncyclic Chronic Pelvic Pain Therapies for Women: Comparative Effectiveness Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov Contract No. 290-2007-10065-I Prepared by: Vanderbilt Evidence-based Practice Center Nashville, Tennessee Investigators: Jeff Andrews, M.D. Amanda Yunker, D.O., M.S.C.R. W. Stuart Reynolds, M.D. Frances E. Likis, Dr.P.H., N.P., C.N.M. Nila A. Sathe, M.A., M.L.I.S. Rebecca N. Jerome, M.L.I.S., M.P.H. AHRQ Publication No. 11(12)-EHC088-EF January 2012 This report is based on research conducted by the Vanderbilt Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA 290-2007-10065-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients. This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied. This document is in the public domain and may be used and reprinted without special permission. Citation of the source is appreciated. Persons using assistive technology may not be able to fully access information in this report. For assistance contact [email protected]. None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report. Suggested citation: Andrews J, Yunker A, Reynolds WS, Likis FE, Sathe NA, Jerome RN. Noncyclic Chronic Pelvic Pain Therapies for Women: Comparative Effectiveness. Comparative Effectiveness Review No. 41. (Prepared by the Vanderbilt Evidence-based Practice Center under Contract No. 290-2007-10065-I.) AHRQ Publicaton No. 11(12)-EHC088-EF. Rockville, MD: Agency for Healthcare Research and Quality. January 2012. www.effectivehealthcare.ahrq.gov/reports/final.cfm. ii Preface The Agency for Healthcare Research and Quality (AHRQ) conducts the Effective Health Care Program as part of its mission to organize knowledge and make it available to inform decisions about health care. As part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Congress directed AHRQ to conduct and support research on the comparative outcomes, clinical effectiveness, and appropriateness of pharmaceuticals, devices, and health care services to meet the needs of Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). AHRQ has an established network of Evidence-based Practice Centers (EPCs) that produce Evidence Reports/Technology Assessments to assist public- and private-sector organizations in their efforts to improve the quality of health care. The EPCs now lend their expertise to the Effective Health Care Program by conducting Comparative Effectiveness Reviews (CERs) of medications, devices, and other relevant interventions, including strategies for how these items and services can best be organized, managed, and delivered. Systematic reviews are the building blocks underlying evidence-based practice; they focus attention on the strength and limits of evidence from research studies about the effectiveness and safety of a clinical intervention. In the context of developing recommendations for practice, systematic reviews are useful because they define the strengths and limits of the evidence, clarifying whether assertions about the value of the intervention are based on strong evidence from clinical studies. For more information about systematic reviews, see www.effectivehealthcare.ahrq.gov/reference/purpose.cfm. AHRQ expects that CERs will be helpful to health plans, providers, purchasers, government programs, and the health care system as a whole. In addition, AHRQ is committed to presenting information in different formats so that consumers who make decisions about their own and their family’s health can benefit from the evidence. Transparency and stakeholder input are essential to the Effective Health Care Program. Please visit the Web site (www.effectivehealthcare.ahrq.gov) to see draft research questions and reports or to join an email list to learn about new program products and opportunities for input. Comparative Effectiveness Reviews will be updated regularly. We welcome comments on this CER. They may be sent by mail to the Task Order Officer named below at: Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, or by email to [email protected]. Carolyn M. Clancy, M.D. Jean Slutsky, P.A., M.S.P.H. Director Director, Center for Outcomes and Evidence Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality Stephanie Chang, M.D., M.P.H. Shilpa Amin, M.D., MBsc., FAAFP Director Task Order Officer Evidence-based Practice Program Center for Outcomes and Evidence Center for Outcomes and Evidence Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality iii Acknowledgments We are indebted to a tireless group of colleagues who made this report possible. Each step of systematic reviews draws on the skills and attention of an entire team. We are grateful for the guidance and methodologic and editing expertise of Dr. Melissa McPheeters, who provided invaluable input for structuring the review and our approach to the literature. Dr. Mark Hartmann brought his attention to detail—and his commitment to perfection—to completion of the evidence tables. His ability to point out inconsistencies and enhance uniformity was key to ensuring smooth development of the evidence tables. Dr. Shanthi Krishnaswami provided an exacting and thorough approach to abstract and full- text review and developing evidence tables. Her input was key in ensuring that all relevant data were extracted and that tables were consistent. Ms. Kathy Lee provided valuable research assistance on this report, helping with logistics, checking and formatting tables, and locating citations. Ms. Rachel Bazan and Mr. Michael Tranchina were our energetic student workers. They spent hours helping to track and file documents and were always positive and always ready to ensure that the project investigators had what they needed to complete this review. Key Informants Esther Eisenberg, M.D., M.P.H. Project Scientist, Reproductive Medicine Network, National Institute of Child Health and Development Department of Obstetrics and Gynecology, Vanderbilt Medical Center Nashville, TN Fred M. Howard, M.D. Associate Chair, Academic Affairs Director, Division of Obstetric/Gynecologic Specialties Professor, Obstetrics and Gynecology University of Rochester Rochester, NY Georgine Lamvu, M.D., M.P.H., FACOG Medical Director Gynecologic Unit of Florida Hospital Orlando, FL Bruce Lessey, M.D., Ph.D. Vice Chair, Research Center for Women’s Medicine, Greenville Hospital System Greenville, SC iv Kerri Schuiling, Ph.D., CNM, WHNP-BC Associate Dean and Director, School of Nursing Northern Michigan University Marquette, MI Eric Wall, M.D., M.P.H. Senior Medical Director, Qualis Health Seattle, WA Rachel Williams, Ph.D. Glaxo Smith Kline Chapel Hill, NC Denniz Zolnoun, M.D., M.P.H. Department of Obstetrics and Gynecology University of North Carolina Chapel Hill, NC Technical Expert Panel Sawsan As-Sanie, M.D., M.P.H. Director, Chronic Pelvic Pain Program and Minimally Invasive Surgery Fellowship University of Michigan Ann Arbor, MI Esther Eisenberg, M.D., M.P.H. Project Scientist, Reproductive Medicine Network, National Institute of Child Health and Development Department of Obstetrics and Gynecology, Vanderbilt Medical Center Nashville, TN Bruce Lessey, M.D., Ph.D. Vice Chair, Research Center for Women’s Medicine, Greenville Hospital System Greenville, SC Steve Phurrough, M.D., M.P.A. Chief Operating Officer and Senior Clinical Director, Center for Medical Technology and Policy Baltimore, MD Frank Tu, M.D., M.P.H. Director, Division of Gynecological Pain and Minimally Invasive Surgery NorthShore University Health System Chicago, IL v Peer Reviewers Mary Lou Ballweg President and Executive Director Endometriosis Association Milwaukee, WI Georgine Lamvu, M.D., M.P.H., FACOG Medical Director Gynecologic Unit of Florida Hospital Orlando, FL Linda McGowan, Ph.D., M.Sc., B.Sc. School of Nursing, Midwifery and Social Work Faculty of Medical and Human Sciences University of Manchester Manchester,