Chronic pain
Pain is the number one reason for seeking medical advice, yet it is unfortunately under-appreciated and under-treated. It often takes a back seat to other symptoms, to the detriment of patients.
In endometriosis, the pain is extremely intense and has a considerable impact on a woman's quality of life. Most of them live with it for years, suffering a double penalty: a lack of appropriate treatment leading to major pain, while at the same time hearing many inappropriate value judgments.
Pain is not inevitable, and specific treatments are available.
Pain mechanisms in endometriosis
Before treatment, it is important to understand the different pain mechanisms associated with endometriosis:
- Inflammatory pain: initial mechanism present at the time of menstruation.
- Neuropathic pain: linked to nerves "trapped in endometriosis lesions".
- Muscular pain: linked to contractures of the pelvic, abdominal and lumbar muscles, which contract in response to pain. The muscles as a whole tense up, locking up and becoming a source of pain in their own right.
- Central sensitization: after long periods of pain, our pain defense systems in the spinal cord and brain are overwhelmed, and can no longer perform their function of modulating painful sensations. Pain information then reaches the brain faster and more intensely. Sometimes, other areas of the body can become painful when they were previously silent.
Types of endometriosis pain
After understanding the mechanisms, it is necessary to identify the different types of pain:
- Pelvic pain
- Pain during intercourse (dyspareunia)
- Digestive pain
- Urinary pain
The combination of these pains leads to real suffering, which becomes difficult to manage on a daily basis.
Pain treatment
Precise analysis of these different types of pain enables us to develop treatments tailored to each patient:
- Disease-modifying treatments: daily medication to reduce central sensitization and neuropathic pain, in addition to hormonal treatment to eliminate menstruation and cyclical pelvic inflammations.
- Crisis treatments: to be used on an occasional basis in the event of pain exacerbation.
Treating pain is not just a matter of administering medication. Non-medicinal treatments have a vital role to play, particularly in disease-modifying therapies.
Gynaecological osteopathy relieves pelvic muscle tension, transcutaneous neurostimulation acts on both neuropathic pain and central sensitization, and acupuncture or hypnosis can also be used.
Comprehensive management of chronic endometriosis pain
It is therefore essential to carry out a multidisciplinary assessment and offer comprehensive care to patients with chronic pain. In our center, this assessment is carried out as part of the day hospital..
Because pain is intense and complex, the first line of treatment will not necessarily be effective in all cases. Nevertheless, patients should remain confident and return for regular consultations to optimize and adapt treatment.
Long-term medical and paramedical follow-up is also essential, to provide ongoing support and avoid isolation and its negative impact on professional, social and family life.
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