Pain is the number one reason for seeking medical attention, yet it is unfortunately underestimated and inadequately treated. It is often considered after other symptoms to the detriment of patients.
In endometriosis, pain is extremely intense and has a considerable impact on a woman’s quality of life. Most women live with this pain for years, suffering from both an absence of appropriate treatment and consequent major pain and too frequent inappropriate value judgments.
Pain does not have to continue as specific treatments exist.
Mechanisms of pain in endometriosis
Before treatment, it is important to understand the different mechanisms of pain associated with endometriosis:
- Inflammatory pain: the initial mechanism present at the time of menstruation.
- Neuropathic pain: related to nerves “trapped in the endometriosis lesions”.
- Muscular pain: related to the contraction of pelvic, abdominal and lumbar muscles in response to pain. The muscles as a whole become tense, locked and a source of pain in their own right.
- Central sensitization: after long periods of pain, our defense systems against pain located in the spinal cord and the brain, become overwhelmed and can no longer ensure their function as regulators of painful sensations. The painful information will then reach the brain more quickly and in a more intense way. Sometimes other areas of the body can become painful although not previously so.
Types of endometriosis pain
After understanding the mechanisms, it is important to identify different types of pain:
- Pelvic pain
- Pain during sexual intercourse (dyspareunia)
- Digestive pain
- Urinary pain
The combination of these leads to a genuine distress becoming difficult to manage on a daily basis.
Detailed analysis of these different types of pain makes it possible to give treatment which is adapted to each patient:
- Basic treatments: medications administered daily to reduce central sensitization and neuropathic pain, in addition to hormonal treatment aimed to eliminate menstruation and cyclical pelvic inflammation.
- Crisis treatments: to be used on an ad hoc basis in cases of pain exacerbation.
Pain treatment does not only concern administration of medication. Non-medicinal treatments have an important role to play especially in long term treatment.
Gynecological osteopathy helps relieve pelvic muscle tension, transcutaneous neurostimulation acts on both neuropathic pain and central sensitization, and acupuncture and hypnosis are also used.
Holistic management of chronic endometriosis pain
It is therefore important to carry out a multidisciplinary evaluation and to propose holistic treatment to patients with chronic pain. In our center, this evaluation is carried out at the day hospital.
As pain is intense and complex, initial treatment will not always be effective. Patients should however remain confident and come back to the clinic on a regular basis to optimize and adapt treatment.
It is also important to maintain medical and paramedical follow-up long term for ongoing support and to prevent feelings of isolation and its harmful consequences on aspects of professional, social and family life.
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