A Perry Perspective...

OBGYN.net: How long has The International Pelvic Pain Society been in existence?

Dr. Perry: We've been around informally for about 4 years. We actually incorporated in 1997, and our first official meeting was in April 1997.

OBGYN.net: What prompted you to take the lead in forming such an organization?

Dr. Perry: Initially, there were approximately 12 physicians who were sensing the need for an organization such as The IPPS. The group consisted of mostly gynecologists, but there was also one urogynecologist and Dr. Mark Elliott, a psychologist.

Dr. John S. McDonald, a board certified anesthesiologist and Ob/Gyn at Ohio State University, should get the credit for the vision. He foresaw the need, and had the creative insight. Unfortunately, he was so busy he really couldn't get everything off the ground.

He and Dr. Elliott had been working in the area of chronic pelvic pain for a long time. Then, there were the other pioneers in the field, including, but not limited to, people like Dr. John Steege and Dr. John Slocumb. But Dr. James Carter, Dr. Fred Howard, and myself desperately wanted to get the organization off and running, because the need was so strong.

It was one of those things where if we didn't do it, then who was going to do it? And if not now, then when?

We've been richly rewarded and have had several meetings now that have been outstanding. San Diego was our largest meeting yet, and we're looking forward to our spring symposium in Hartford, Connecticut. Again in 1999, our fall symposium will be held immediately prior to the American Pain Society meeting in Ft. Lauderdale, Florida. I strongly encourage you to attend this meeting, as we have a full roster of excellent presentations on the agenda, and we certainly welcome new faces as well as our old colleagues and friends.

OBGYN.net: What were your principal motivations in starting The International Pelvic Pain Society?

Dr. Perry: There is a tremendous lack of science in chronic pelvic pain. It's obvious to anybody who has an interest in this problem and who really devotes time trying to help people who are suffering that a multidisciplinary approach to chronic pelvic pain is needed -- not just a gynecologist.

What you need is a neurophysiologist, a psychologist, a physical therapist, an anesthesiologist, a urologist, a pharmacologist, a nurse, and, yes, definitely, a gynecologist too. Without the cross-pollination that a multidisciplinary approach can provide, you're going to miss important pieces of the puzzle because the problem is so complex.

And so our motivation in starting The IPPS was two-fold: to begin with, we wanted to educate healthcare professionals -- anyone who was interested in the problem, because the urologists need the gynecologists, the physical therapists need the pharmacologists, and so on. We all need each other to get maximum benefit and maximum impact.

Secondly, we wanted to educate patients. There are so many people out there who suffer and having seen someone in healthcare are told there's nothing that can be done about the problem. Patients like these either get so depressed and frustrated that they just kind of withdraw, or they get very aggressive and do everything they can to help themselves, sometimes seeing someone who doesn't really have a good understanding of the problem. Consequently, they wind up being mistreated, which makes the problem worse. We'd like to play a key educational role that can help to prevent both the withdrawal and the mistreatment of women who suffer from this devastating illness.

OBGYN.net: What strategy will you employ in achieving these goals?

Dr. Perry: We see our first order of business as helping to educate the healthcare community. We would like everyone in the healthcare system to know what we know, and to work with us in finding additional answers that can benefit chronic pelvic pain patients. If we can help to educate physicians and other healthcare professionals throughout the country and around the world about the problem, then women who suffer from chronic pelvic pain will have ready access to someone who understands their problem, irrespective of geography. So that's our first goal.

We're not making a push to try to get patients to self-refer to us. Instead, we're trying to educate physicians so they'll be available to the women suffering, no matter where these women are. We prefer to have patients who come in to see a chronic pelvic pain specialist be physician-referred, rather than self-referred. As anyone who has worked in chronic pelvic pain for any length of time knows, there is certainly no shortage of patients with the problem. What we need now is more healthcare professionals who have the appropriate knowledge base to understand these patients and the clinical tools to help them. We hope to facilitate both the development and the dissemination of that knowledge base, and make it easier for our fellow healthcare professionals to tap in, as it were.

OBGYN.net: Do you plan to conduct research into chronic pelvic pain?

Dr. Perry: Yes, definitely. That's a priority for The IPPS. Until we understand the mechanisms involved, we'll never be able to cure the disease.

We're fortunate to have an excellent research committee, chaired by Dr. Deborah A. Metzger. Our goal is to try to standardize a history and physical examination for patients with chronic pelvic pain, so nothing is missed. Once completed, we're going to make it available to everybody. We also have two research projects in process -- one on conscious pain mapping and the other on uterine suspension. This is the first time that randomized, controlled trials have been applied to these techniques. So I think we'll make some headway.

OBGYN.net: What about information for healthcare consumers?

Dr. Perry: Our patient education booklet is now complete and available for downloading from the 'Resources' section of our web site at www.pelvicpain.org. This booklet will help consumers to be aware of some of the complex issues involved in treating chronic pelvic pain. Dr. Michael Wenof has done an excellent job as chair of our Patient Education Committee in producing this booklet."

OBGYN.net: Please tell us a little about your background, Dr. Perry.

Dr. Perry: I'm an Ob/Gyn by training, who is committed primarily to pelvic pain. I stopped doing OB about three years ago so I could devote more time exclusively to chronic pelvic pain. I am certified in pain management, and I established the Chronic Pelvic Pain Treatment Center in Birmingham, Alabama, a referral-based practice. I'm also an Assistant Professor at the University of Alabama at Birmingham, Department of Gynecology.

OBGYN.net: Do you think more clinical research centers are going to spring up around the country, devoted to chronic pelvic pain and related problems?

Dr. Perry: That would be my hope. We're beginning to understand a lot more about the underlying neurophysiology of the problem. We're beginning to understand that it's not just physical and not just psychological -- we're more completely understanding the interplay of the two factors. Chronic pelvic pain is coming back into the realm of academia as a legitimate science. And so, yes. I think we'll see more pelvic pain centers affiliated with health science centers and medical schools.

OBGYN.net: Do you have a specific message for our OB/Gyn audience?

Dr. Perry: Every gynecologist needs to know at least some of what we're talking about. Unfortunately, you're not taught it in your residency, and you don't get it in your clinical practice unless you really dig. We would like to serve as a ready resource for physicians who really have an interest in chronic pelvic pain but who don't know how to go about developing care for these women. And whatever we can do to facilitate the greater distribution of this knowledge, that's what we want to do.

Of course, the pelvic pain patients themselves are becoming ever-smarter, ever better informed about this problem. I think it would be perceived as somewhat threatening to clinicians who trained 10, 15, or 20 years ago to have patients with more knowledge in this area than they themselves have. And there's a real danger of that right now. So we are trying to do everything we can do to get the professionals caught up, to bring them up to speed.

OBGYN.net: Thank you, Dr. Perry, for a very informative and stimulating interview.

Dr. Perry: And thank you, Joel, for giving me this opportunity to communicate with your audience.

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Editor's note: To learn more about The International Pelvic Pain Society, or to lend your support by becoming a member, contact:

The International Pelvic Pain Society

Suite 402, Women's Medical Plaza

2006 Brookwood Medical Center Drive

Birmingham, Alabama 35209 USA

(205) 877-2950

1-800-624-9676

FAX: 205-877-2973

e-mail: pelvicpain@aol.com

Website: http://www.pelvicpain.org