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Relief From Chronic Pelvic Pain

Many women -- and their doctors -- never realize the mysterious pain they feel has a diagnosis.
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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.

Perry adds that for most patients, opioid drugs should be avoided. "That's not an absolute, because some patients can't function without them. But the danger of opiods is you can end up with two problems: chronic pelvic pain and dependency."

Perry says it's now understood that women should try to avoid multiple surgeries as it can set up a cycle of pain, surgery, more pain, more surgery, etc. "We try to teach minimally invasive surgery because it helps prevent upregulation to the spinal cord," he says.

He adds that women should avoid emergency room visits unless absolutely necessary. "A patient can get into a vicious cycle of pain crisis, ER, getting a shot, going back in the next month. We never tell them to stay out of the ER if there's a problem, but if it's the same-old, same-old, it can interfere with their treatment plan. ER doctors focus on the pain crisis. They may not understand why someone is hurting with so little pathology and tend to dismiss them as drug seekers, when usually they're relief seekers."

Chronic pain can take over a woman's life, but experts now advise staying active, working, and engaging in physical activity. "Low-impact aerobics might be good," says Grzesiak. Some studies have suggested that physical therapy and exercise may be effective for chronic pain relief.

"We discourage patients from getting on disability," says Perry. "That's a downward spiral. We encourage functionality and distractions. Young women should stay in school. Others should keep working, at least some."

Metzger has found that many patients test positive for allergies to foods, such as wheat, soy, corn, rice, and baker's yeast. "When we get them off the food they're allergic to, their pain goes away." She adds that vulvar pain may be related to allergies to skin fungi. "When we desensitize patients with daily, sublingual [under the tongue] drops, the pain goes away."

She's also seen results in patients who go on the Sugar Busters diet. "Money isn't the root of all evil," she says. "Sugar is."

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