Puzzling Over Pelvic Pain

March 10, 2010

According to the National Pain Foundation, 12%-20% of all women experience chronic pelvic pain. Some 61% of them remain undiagnosed, though women may search for a cause of their pain and a solution for years. Ultrasound is a conservative method that may or may not pinpoint the reason for a woman's pelvic pain. When all else fails, doctors may perform a laparoscopy.

A laparoscopy is a surgical technique in which the physician will insert a lighted telescope into the woman's abdomen. More and more, physicians are resorting to laparoscopy to diagnose a woman's chronic pain. This is according to a study that was published in a January 2010 issue of Archives of Gynecology and Obstetrics.

Definitive Diagnosis

Laparoscopy is the only way to obtain a definitive diagnosis for the disease known as endometriosis. This debilitating condition affects some 90 million women worldwide. Without laparoscopy to diagnose and locate the extra-uterine tissue that characterizes endometriosis, a woman cannot receive appropriate treatment for her chronic pelvic pain.

Andrew Cook, a pelvic pain and endometriosis expert says that the kind of chronic pelvic pain that comes with endometriosis is a complex situation. "There are so many things that can cause pelvic pain," says Cook who is a founder of the Vital Health Institute where he is the acting medical director. Among the causes of chronic pelvic pain are irritable bowel syndrome (IBS), interstitial cystitis, endometriosis, or even a problem related to processing pain signals. Cook says that as in fibromyalgia, another chronic pain condition, sometimes it's just a communication problem in which "the whole communication up and down the spinal cord changes and it gets hypersensitive," says Cook.

Wider Recognition

As fibromyalgia and other chronic pain conditions receive wider recognition, so too, chronic pelvic pain is beginning to be accepted as a real phenomenon. But it seems as though some women are just wired to have pain in this area, though doctors haven't figured out why this should be so. "It appears there is a section of the population that is genetically and environmentally predisposed to have changes in their neurological system that cause them to have chronic pain, and that becomes the diagnosis," says Fred Howard, chairman of the board of the International Pelvic Pain Society. Howard is also a professor at the University of Rochester where he is the associate chair of obstetrics and gynecology for the University's Medical Center.

Doctors prefer to treat chronic pelvic pain as if it has been established as this type of pain processing problem and so they view it as a pain management issue. Physicians may refer women to physical therapists or pain management clinics if pain medication fails to bring relief. The only other recourse is surgery, a more drastic solution. George Washington University School of Medicine's Anthony Scialli, who is a clinical professor of obstetrics and gynecology at this institution explains, "We think of chronic pelvic pain as a regional pain syndrome." Scialli, who has researched chronic pelvic pain says, "People with pain processing problems have abnormalities of sleep and mood and have other pain," for instance joint pain, neck pain, or headaches. "The fact that it's not isolated suggests that it's a more global pain processing problem."

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