Chronic Pelvic Pain
An excellent article about persistent pain in the abdomen and pelvis and its links to other conditions was published in in June 2022.
Obstet Gynecol Clin North Am. 2022 June ; 49(2): 219–239. doi:10.1016/j.ogc.2022.02.006.
"At least 15–20% of women suffer from chronic pelvic pain, which is defined as pain occurring in the abdomen or pelvis for at least 14 days per month and is severe enough to cause functional limitations or prompt medical care.1 This condition has a profound impact on physical health, emotional well-being, and ability to function across family, social, and professional roles. Chronic pelvic pain is notoriously challenging to manage, frustrating patients and clinicians alike.......
"......Patients with chronic pelvic pain very frequently suffer from other non-pelvic pain conditions, particularly those that comprise the Chronic Overlapping Pain Conditions (COPCs). COPCs are a set of chronic pain conditions that have a highly probability of co-occurrence and appear to share common underlying mechanisms and risk factors. Two gynecologic pain conditions are included in the National Institutes of Health Pain Consortium list of COPCs: endometriosis and vulvodynia. But COPCs also include both pelvic (interstitial cystitis/bladder pain syndrome and irritable bowel syndrome) and non-pelvic conditions (fibromyalgia, temporomandibular disorders, migraine headache, chronic tension-type headache, chronic low back pain, and myalgic encephalomyelitis/ chronic fatigue syndrome). The conditions that contribute to chronic pelvic pain symptoms in one person often differ greatly from those that contribute in another and can change in any given patient over their life course.
"Presence of persistent pain, regardless of specific etiology or location, can lead to increased sensitization of the central nervous system – in other words, predisposing patients to development of additional chronic pain conditions.3,4 Notably, patients with multiple chronic pain conditions often respond less robustly to treatments focused on individual conditions.5–7 Therefore, it is essential to approach management of chronic pelvic pain in a comprehensive manner, which includes identification of all conditions that contribute to pain symptoms and optimal management of each contributing condition."
You may have heard of someone with "phantom limb pain" in a person who has had a limb amputated - often they can still feel the toes in a missing leg. This is because each part of our body is represented on the surface (cortex) of the brain and the brain can produce, reproduce, or perpetuate any sensation, even when a part of the body is no longer present or has healed. Chronic pelvic pain is similar - it may occur in someone who has had previous illness, injury, or assault, or who has had an unhappy relationship leading to fear of intimacy. The pain may persist long after any injury or illness has healed and there is no longer any structural reason for it - the neural circuits continue to fire, giving the sensation of persistent pain. In some cases vulvodynia - persistent pain in the vulva - can behave in a similar way.
Once serious structural conditions have been excluded by appropriate medical examination, laboratory tests, and imaging, it is appropriate to consider safe and effective ways of managing it without invasive surgery or potentially hazardous drugs. Pain Reprocessing Therapy and clinical hypnosis are two such safe, respectful, and effective therapies offered at our office.
The first Clinical Hypnosis course I took when making the shift from family medicine to pain rehabilitation was with Dr. Elvira Lang, a consultant radiologist who has published extensively on the usefulness of hypnosis in relieving anxiety and claustrophobia in procedural medicine. That workshop was hosted by the Canadian Society of Clinical Hypnosis - Ontario Division. Dr. Lang teaches all over the world using what she has called Comfort Talk. It is applicable to physicians, dentists, X-Ray technicians, radiologists and anyone working in surgical or interventional medicine. Here is her latest article.
Easing your prioperative practice through Comfort Talk®
David is a fan of books and no doubt will be sharing some good reads here.