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
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