Conservative Care for Pelvic Pain (C2P2) in Women Service Members

Baylor University

Status: Not yet enrolling

Conditions: Chronic Pelvic Pain

Treatments: Other: Extrapelvic Dry Needling; Other: Chronic Pelvic Pain Education; Other: Extrapelvic Manual Therapy; Other: Intravaginal and intrarectal pelvic floor physical therapy; Other: Deep Paced Diaphragmatic Breathing Training; Other: Lumbopelvic and Hip Therapeutic Exercise; Other: Pain Neuroscience Education

Study type: Interventional

Funder types: Other; Other U.S. Federal agency

Identifiers

NCT06697548

OR230127

HT94252410709 (Other Grant/Funding Number)

Details and patient eligibility

About

This study will test the effectiveness of emerging conservative interventions for treatment of chronic pelvic pain (CPP) that can be performed without intravaginal specialization. Participants with CPP will be randomly assigned to one of three groups. The first group will receive treatment based on what they normally would receive, including medications, education, and exercise (Usual Care Group). The second group will receive contemporary non-vaginal treatment including manual therapy, dry needling, and specific breathing training (Emerging Field-expedient Care Group). The third group will receive intravaginal treatment by a pelvic health specialist (Gold-standard Intravaginal Specialist Care Group). Participants will be asked about their pain and symptoms and have measurements taken of their pelvic and back muscles after 1, 3, 6, and 12 months. In addition to seeing which treatments work best, clinical decision tools (using medical and trauma history along with clinical examination) will be developed to identify women with CPP likely to respond favorably to non-vaginal conservative interventions. This study will help determine the best non-vaginal treatment strategies for women with CPP and help clinicians quickly determine which patients are likely to benefit from treatment by non-pelvic health physical therapists (e.g., in theater), vs. patients who should be referred for pelvic health specialty care.

Full description

This trial will measure both clinical outcomes (pain, pelvic floor symptoms, work/duty absenteeism) and physiologic outcomes (pelvic floor and lumbopelvic muscle function and pain sensitivity) at 1 week and after 1, 3, 6, and 12 months of three different conservative physical therapy treatments. It is hypothesized that women who receive emerging field-expedient care will report greater improvements than those who receive only usual care, and their outcomes will be no worse than women who receive gold-standard intravaginal specialist care. Additionally, clinical decision tools incorporating characteristics from medical and trauma history, along with clinical examination, will be developed to identify women with CPP likely to respond favorably to emerging field-expedient care vs. requiring gold-standard intravaginal specialist care.

Enrollment: 300 estimated patients

Sex: Female

Ages: 18 to 50 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. Pain of at least 3 months duration in the abdominal-lumbopelvic area, defined as below the umbilicus, between the two ilia, and above the pubic symphysis including the vulvar, perineal, and vaginal regions.

Exclusion criteria

1. Sign that pelvic pain may be due to other serious medical issue (recent history of abdominal pelvic surgery, current infection, disrupted tissue integrity, neoplasm, or history of radiation to the pelvic floor tissue or the tissues being measured for stiffness).
2. Chronic debilitating medical conditions (e.g., fibromyalgia, lupus, complex regional pain syndrome, multiple sclerosis or other progressive neurologic condition).
3. Currently pregnant or pregnancy in the last 6 months.
4. Body mass index over 33 (Waco participants only due to limitation of the instrumentation).
5. Soldiers in an Advanced Individual Training (AIT) status.
6. Previous intervention to address lumbopelvic muscle stiffness or pain such as dry needling, injections, or soft tissue intervention of any kind in the past 6 months.
7. Inability to read English at an 8th grade reading level (any participant unable to read the informed consent form, which will be written at an 8th grade level).
8. Inability to legally provide informed consent for any other reason.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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300 participants in 3 patient groups

Usual Care

Active Comparator group

Description:

Usual Care Group will receive their current medical management care along with study-specific patient education and progressive home exercise.

Treatment:

Other: Lumbopelvic and Hip Therapeutic Exercise

Other: Chronic Pelvic Pain Education

Emerging Field-expedient Care

Experimental group

Description:

Emerging Field-expedient Care Group will receive a combination of emerging nonvaginal interventions aimed at normalizing sensory, motor, and autonomic nervous system dysfunction including pain neuroscience education, diaphragmatic breathing training, and lumbopelvic manual therapy and dry needing treatment

Treatment:

Other: Lumbopelvic and Hip Therapeutic Exercise

Other: Pain Neuroscience Education

Other: Deep Paced Diaphragmatic Breathing Training

Other: Extrapelvic Manual Therapy

Other: Chronic Pelvic Pain Education

Other: Extrapelvic Dry Needling

Gold-standard Intravaginal Specialist Care

Active Comparator group

Description:

Gold-standard Intravaginal Specialist Care Group will receive tailored intravaginal and intrarectal manual therapy and biofeedback intervention by a pelvic-health specialist.

Treatment:

Other: Lumbopelvic and Hip Therapeutic Exercise

Other: Pain Neuroscience Education

Other: Deep Paced Diaphragmatic Breathing Training

Other: Intravaginal and intrarectal pelvic floor physical therapy

Other: Chronic Pelvic Pain Education