If you have pain on most days, or several different pains, you may have wondered why your body is so sensitive. Someone may have told you ‘it’s all in your head’. You don’t need to worry that you are weak, or that the pain is imaginary. It’s real, but it may be something you haven’t thought of.
Often it is a change in the way the nerves, spinal cord and brain work called neuropathic pain or central sensitization. Pain from nerves is yet another pain you can’t see at a laparoscopy, and part of what doctors call the “Chronic Pain Condition’
“Pain Hurts, Pain is Real, Pain is not INVISIBLE”
How did it happen?
When something painful happens to us, the nerves in that area send pain signals to the spinal cord and then up to our brain. It is when the brain notices the pain that we feel it. Sometimes, after bad pain, or if there has been pain for a long time, the pain pathways from the pelvis to the brain change. The structure of the nerves change and they start sending pain impulses to the brain at any time, not just when something painful is happening. The brain changes too, and starts to feel pain even with normal sensations like touch or normal bowel function.
Central sensitization is very common in women with pelvic pain, but it is also common after back injuries, or shingles. The pain that is felt long after a badly injured leg is amputated (Phantom Limb Pain) is another type of neuropathic pain.
Do I have the Chronic Pain Condition (neuropathic pain)?
Chronic pain is a medical condition, just as asthma, diabetes and endometriosis are medical conditions, but it involves the way nerves work.
Around 20% of people (men and women) seem to be at risk of developing a long term pain condition. Often there are a mix of different pains. For example, a woman with pelvic pain might also have tender points in the muscles around her shoulders, headaches on most days, long term pain after an injury or an irritable bowel. Brain scans show that in someone with neuropathic pain, even small things are seen by the brain as pain.
There are no scans or blood tests that show neuropathic pain, but once you understand it, neuropathic pain is quite easy to pick:
- It can come on at any time, and is usually present on most day
- The pain may be burning, sharp, or aching
- It is common to feel bloated, even if you look normal
- It is common to sleep badly
- Things that would not normally be painful, are painful. Some women feel pain just with touching their abdomen. This is called ‘Allodynia’
- Things that are painful become more painful. For example, periods may have always been painful, but are now very painful. This is called ‘Hyperalgesia’
- When the pain is really bad, you may feel it over a bigger area. This is called ‘Wind-up pain’
What can I do? Things have just become too much for me
Neuropathic pain affects our mood too. Women who have managed their pain well for years, may start to feel ‘worn down’ by their pain or anxious about things they don’t need to be anxious about.
We know that some of the same chemicals involved in neuropathic pain are also involved in anxiety and depression, so once again, you are certainly not imagining it. These problems often improve once the pain is treated.
Once chronic pain becomes established, a cure may not be possible, but the good news is that you can expect a big improvement with management of your pain. These treatments will help your nerves work normally again:
Lifestyle. You may have worked out already that your pain is worse if you are stressed or over-tired. Being kind to yourself is important but doesn’t mean lying on a couch all day. It means regular gentle exercise, a good diet, a positive attitude, regular sleep, and resolving stressful issues. Chronic pain is not dangerous, but it is painful. Look for the things in life you can enjoy and stay active. A positive attitude really helps.
Medications every day to help the nerves work normally. These medications are not painkillers, but help pain when taken regularly. No one wants to take a regular medication, but we recommend you see your doctor and try them at least for a couple of months. Then think about the problems you had before and decide if they have been helpful:
amitriptyline is an old-fashioned medication that used to be used in big doses to treat depression. Small doses won’t treat depression but often help nerve pain, sleep, headaches, a bloated feeling, an overactive bladder and muscle pains. It suits around half the women who try it. If it makes you too sleepy, you can change to nortriptyline instead.
duloxetine is particularly useful for women who have pain, anxiety or low mood. Most anxiety medications (called SSRI’s) don’t help pain, but duloxetine is SSRI and SNRI (helps pain) as well. So, if you are taking an SSRI medication, you might choose to discuss the option of duloxetine and whether it might suit you with your doctor.
pregabalin or gabapentin. These are different medications you can discuss with your doctor. Start on a small dose and work up. There is no hurry.
There are information sheets on all these medications at www.pelvicpain.org.au
Content provided by Dr Susan Evans, Gynecologist, Laparoscopic Surgeon, & Specialist Pain Medicine Physician (https://www.drsusanevans.com.au/). Permission has been granted to publish this content on www.theendolifestyle.com.