HI. Thanks for your query. Read the history and understood your wife s problem. The reason of lower abdominal pain with back pain for 4 months can be the following : Pelvic inflammatory disease - PID Endometriosis. Diseases of the ovaries and / tubes Enteritis Colitis Myometritis. As the caeserian section was 18 months ago, this may not be related to the present problems. The medicines given by Her Gynecologists are based on the reports , which you say OK. Gynecologist must have done an internal examiantion and thought of PID or Endometriosis as a major cause hence gave the medicines. Also must have thought about anxiety or stress hence added few more medicines like trypromer ans so. I think these are good medicines but if htey are not helping , we have to think about other causes. In such a case I would advise the following: CT scan of the abdomen Diagnostic Laparascopy has a major role to play and this is a common practice now. It allows the direct visualization of the whole abdomen, its contests, particularly, uterus , tubes and ovaries in this case. Hence the diagnosis m biopsy and treatment can be undertaken in a large number of patient. Please discuss this with your Gynecologist or take a second opinion of a General Surgeon practicing Laparoscopic surgeries, Or a Gastro Surgeon.