Treatment of Chronic Pain
A full discussion of this subject is outside the
scope of this article and I would recommend visiting
the World
Congress on Pain, International
Pelvic Pain Society and the Endometriosis
Society for more information. The American
Society for Reproductive Medicine has an excellent
booklet on pelvic pain which is worth reading.
The first step towards treatment is of course diagnosis,
and your doctor will take a history, examine you and
possibly conduct some tests, in an attempt to determine
the cause of pain. These tests may include a
laparoscopy.
In limiting my remarks to patients in whom ADHESIONS
are believed to be the cause of pain, I will start
out by saying that there are no easy answers.
There may not be a cure for the pain, but it may be
controlled to a more acceptable level. For reasons
stated above, adhesiolysis may not be the answer and
may not even be the first choice. I would certainly
ask your doctor if s/he might consider an adhesiolysis.
If s/he was able to use an ADHESION barrier, s/he
needs to read the product label to determine whether
it is appropriate. If extensive adhesiolysis
surgery is required, often a general surgeon will
be (and should be) asked to collaborate with the gynecological
surgeon. Pain
mapping is an emerging technique where, under
local anesthetic, the surgeon attempts to locate the
focus of pain by prodding different areas within the
pelvis. Sometimes pain is associated with adhesions,
and sometimes adhesions (or even loci of endometriosis)
do not appear responsible for the pain. If an
endometriosis site is discovered and removed, this
should be covered with an adhesion barrier.
I would also seek the counsel of a pelvic pain specialist
who may suggest other treatments including trigger
point injections, neuroablative procedures (where
certain nerves from the 'source' of the pain are cut)
as well as drug treatments, physical therapy, exercise
and dietary changes. In extreme cases where
bowel function is disturbed, comprehensive nutritional
support is a necessity.
Dr.
C. Paul Perry has pointed out:
"It is very important
that we have realistic expectations when
dealing with chronic pelvic pain. The pain
has occurred over a long period of time
and will not go away in a short period of
time. Your recovery will be a process.
Many modes of therapy will be used over
the course of your treatment." |
The treatment of chronic pelvic pain is emerging
as a multidisciplinary specialty. A team
of nurses, psychotherapists, physical therapists,
pain specialists, anesthesiologists, urologists, gynecologists
and general surgeons working in a coordinated manner
can mean maximum benefit for the patient. Not
only is the problem of pelvic pain is receiving the
attention is deserves, but the team approach to its
management is being recognized as one with merit,
as a recent
conference attests.
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