I attended a very fascinating conference over the weekend. The event was hosted by the International Pelvic Pain Society in Chicago, Illinois. Throughout the 4-day event, a common thread linked many common pain syndromes of the anatomic structures below the umbilicus and above the upper thighs. Such ailments include chronic pelvic pain, Irritable Bowel Syndrome (IBS), Interstitial Cystitis (IC) and other bladder pain syndromes, dyspareunia (pain with intercourse), vulvar pain, vaginal itching/pain, hip pain, fibromyalgia, postoperative pain, back pain, endometriosis.Twenty percent of women suffer from chronic pelvic pain (CPP). The typical patient with CPP doesn't look "sick", is frequently embarrassed by her symptoms, fears she will not be taken seriously by her doctor and has difficulty speaking to loved ones about her symptoms. Sufferers of CPP frequently experience alienation, hopelessness, anxiety, depression, suicidal ideation, sleeplessness, narcotic addiction concerns, sexual dysfunction, loss of relationships and loss of employment.
Women who seek medical advice for CPP are often discouraged as so many are told, "There is nothing else in there that could hurt - everything we have looked at is normal." The pelvic muscles, ligaments and nerves of the pelvis are the common denominators in CPP - regardless of the etiology.
The basics of the chronic pain cycle: (1) recurrent activation of the afferent nerves from the source of pain to the dorsal horn of the spinal cord; (2) prolonged release of neurotransmitters in the dorsal horn including substance P; (3) upregulated inflammatory response and release of other neurotransmitters in the dorsal horn; (4)resultant loss of sensitivy or hypersensitivity of the tissue pain source with expansion of the receptive field; (5) prolonged exposure to painful stimuli eventually causes centralization of the pain (i.e. communication with the brain) and local upregulation of pain fiber generation and inflammation resulting in hypersensitivity to pain and organ dysfunction (6) resulting in muscular contraction, other tissue changes and ultimate end-organ dysfunction.
The goals of chronic pain management consist of removal of the noxious stimulant if still present, and modulating the neurological and immune response (i.e. neuromodulation) to an insult. Examples of neuromodulation include biofeedback, drugs with neurotropic and psychotropic effects (oral and topical), soft tissue manipulation and utilization of neurostimulatory devices that stimulate including TENS units, acupuncture and sacral nerve stimulation. The suggested treatments vary according to the type and source of pain. Research indicates that peripheral pain is best treated with topical applications whereas visceral (organ e.g. bladder) pain is best treated with dorsal horn nerve activation.
Little was mentioned regarding complementary and alternative therapies for CPP other than hypnosis for IBS and acupuncture for IC. Lifestyle modification has proven beneficial for those with chronic inflammatory conditions, including CPP. Such alterations in every-day behaviors serve most people well, such as following an anti-inflammatory diet, consuming anti-inflammatory supplements, smoking cessation and limiting exposure to other environmental toxins. Because the efficacy of hypnosis in treating IBS has proven to be helpful, presumably other mind-body approaches should be consider (e.g. mindfulness meditation, Tai-chi, Yoga, guided imagery, art therapy, music therapy, aromatherapy, etc.) Energy therapies should also be considered as acupuncture has already proven helpful. It is important that these treatment modalities be subject to scientific inquiry in reference to treatment of CPP.
Congratulations and thanks to those scientists who continue to pursue additional knowledge. My learning has just begun.
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