A remotely delivered 12-week pain management programme is being tested against standard care for women with endometriosis whose chronic pain persists after surgery or medication. Endometriosis affects 1 in 10 women, causing pelvic pain and fatigue, with no known cure. Pain recurs in 50% of cases within five years after surgery and hormonal treatment, leaving many women with limited options. This trial addresses the lack of evidence for whether a tailored pain management programme—combining cognitive behavioural therapy, physiotherapy, and education—can improve quality of life when standard treatments fail. If the programme proves clinically and cost-effective, it could change how the NHS manages refractory endometriosis pain. The findings may influence NICE and ESHRE guidelines, offering a non-surgical, non-hormonal option for women who prioritise fertility or cannot tolerate side effects. Cost-effectiveness data would also inform resource allocation and policy, potentially reducing healthcare use by helping women manage pain without repeated surgeries or emergency visits.
View original technical description
Research Question: Is an endometriosis-specific pain management programme (e-PMP) clinically and cost-effective for endometriosis-related chronic pain not adequately controlled by surgery and/or pharmacological treatment? Background: Endometriosis affects 1 in 10 women, causing pelvic pain, fatigue, and reduced quality of life (QoL). There is no known cure. Treatment typically involves surgery or hormonal medications, which have side effects and limited long-term effectiveness, with pain recurring in 50% of cases within 5 years after surgery and hormonal treatment. Pain management programs (PMPs) may improve QoL in chronic pain conditions but require more evidence for endometriosis. Aims and Objectives Aim: To determine if e-PMP in addition to standard care is clinically and cost-effective for improving QoL in women with endometriosis-related chronic pain. Objectives: To compare e-PMP plus standard care with standard care alone at 12 months post-randomisation in terms of: 1) health-related QoL, functional health, and well-being; and 2) cost-effectiveness in terms of the incremental cost per QALY gained at 12 months and long-term modelling. Methods: A superiority RCT will compare e-PMP plus standard care with standard care alone in premenopausal women aged 16 years and above with persistent endometriosis-related chronic pelvic pain not controlled by surgical and/or pharmacological treatment. The e-PMP is a remotely delivered 12-week interdisciplinary program combining Cognitive Behavioural Therapy (CBT)-informed psychotherapy, physiotherapy, education on endometriosis, pain and fatigue management, aiming to reduce pain-related distress and improve QoL. The e-PMP alternates between group-based and 1:1 sessions; totalling 2.5 hours per week with a booster session at 24 weeks. Session content will introduce the role of psychology and physical activity in pain management, provide information to help people understand their condition/symptoms and persistent pain, explore activity and fatigue management, flare-ups, values, management of pelvic floor dysfunction, relationships, intimacy, communication, self-compassion, and optimise pain medications to reduce side effects. Timelines for delivery: Start date: 1 January 2026; Study duration: 60 months. Milestones: prefunding (regulatory approvals, site engagement); months 1-9 (set-up, authorisations, site training); months 10-39 (patient recruitment); months 40-51 (patient follow-up to 12 months); months 52-60 (follow-up, data analysis, reporting). Impact and dissemination Impact: Findings will influence endometriosis care guidelines (NICE, ESHRE), provide more treatment options for women with refractory endometriosis pain, including those prioritising fertility, and reduce healthcare use. Cost-effectiveness data will inform resource allocation and policy. Dissemination: Results will be shared with clinicians, academics, patients, and policymakers through publications, conferences, media outreach, and plain language summaries on social media, University and endometriosis charities' websites, and a video summarising findings for patients.
Plain English summaries and category classifications on this site are generated by AI and may not perfectly reflect the original research.
Is something wrong? Let us know