Quick, what disease affects 25% of the world’s women? Chronic pelvic pain. What’s the cause? We don’t know. But we have a treatment.
Surgeons have decided that chronic pelvic pain is caused by varicose veins in the pelvis. The disease has been termed pelvic congestion syndrome, pelvic venous congestion, or pelvic vein incompetence. Specifically, these veins tend to be around the ovaries. Ignoring that women without any pain also have these varicose veins, surgeons are currently cutting or blocking the veins with some success.
The number of studies on Pelvic Congestion Syndrome makes it almost non-existent (242 studies, bunions have 3,000 studies). We don’t have definitive studies that show that the varicose veins cause the pain, but we do have pain relief for patients who’ve had the surgery. This varies from half to 75% of women, which is a good number unless you realize that almost half of the women undergoing blockage of their veins continued to experience pain. If the venous congestion causes the pain, and you resolve the congestion, wouldn’t we expect a near-universal decrease in pain?
Pain is the symptom most likely to respond to a useless intervention. A recent acupuncture study found that almost half of the placebo group felt pain relief for chronic pelvic pain (compared to 92% of those actively treated). For placebo response, surgery is particularly likely to give a high response rate (see Huffington Post discussion). And without large-scale trials, blocking the veins in the pelvis may not be that effective.
But what if it is? Other studies show that an imbalance in estrogen may make the difference in whether or not a woman experiences pelvic pain. Surgery blocking the veins to the ovaries doesn’t just affect pain. According to one case report “(a)fter the treatment, all subjects experienced a dramatic decrease in pelvic pain, as well as an improvement in two or more preexisting symptoms, including extremity swelling, dyspareunia, external varicosities, constipation, and emotional disturbance.” All that from a little vein blocking? Yes, because blocking the flow from the ovaries would also affect the amount of estrogen they secrete into the body.
It may seem backhanded to apply a surgical solution to a hormonal imbalance, but for women with chronic pain the payoff may be worth it. Especially if they have searched for years for a diagnosis and hit upon something that sounds official. We have a diagnosis: Pelvic Congestion Syndrome. We have a solution: a low risk surgical blockage of those veins. We have outcomes: a great number of women experienced pain relief. And we have very few other options being offered. The lack of randomized trials or high quality trials means little to someone in chronic pain.