Relief From Chronic Pelvic Pain
Many women -- and their doctors -- never realize the mysterious pain they feel has a diagnosis.
New Understanding of Chronic Pelvic Pain continued...
He says the neurobiological effects of trauma are complex and don't always make sense from a biological scientist's point of view. Grzesiak is the author of A Psychological Vulnerability to Chronic Pain.
"The terror and violation of the body do not go into one's memory system as 'I have been raped,' or 'I have been violated,'" Grzesiak says. "It goes into the non-linguistic side of brain as the experience of terror and as the feeling of being violated, not as the memory of the event."
In addition, he says trauma speeds up the nervous system so that any painful sensation is perceived to be severe. "These patients can't graduate pain, like it's a two or three or four. The pain is either off or on, and when it's on it's severe."
Another effect of trauma that's being explored has to do with issues of a patient's trust. "They may have difficulty trusting health care providers," says Grzesiak, who is also clinical associate professor of psychiatry at UMDMJ-New Jersey Medical School in Newark. "Invasive surgeries and a lot of medical procedures violate people. The physician is doing something that's made them anxious all their lives."
Chronic Pain Treatment
Perry, medical director of the C. Paul Perry Pelvic Pain Center in Birmingham, Ala., says certain antiepileptic drugs -- especially Neurontin but also Pregabalin, Depakote, and others -- are effective in treating chronic pelvic pain.
It's important to treat depression in chronic pelvic pain, says Perry. Some studies have shown that antidepressants can improve pain levels and pain tolerance in women who have chronic pelvic pain.
"Eighty to 90% of CPP patients have depression," Perry says.
"The medications we've had the best results with for depression and neuropathic pain are Cymbalta and Effexor," he says. "There are other SSRIs that are good for depression, and you'd think they would help, but those two drugs are the only ones substantiated in the literature."
Metzger sometimes combines Elavil or Neurontin with medications such as Allegra and Singulair. In addition, she advises patients who have severe vulvar pain to spray Nasalcrom, an over-the-counter nasal spray, directly on the vulva.