Managing Chronic Pain

submitted by Endometriosis Research Center

Endometriosis is often a painful and sometimes even debilitating condition. The pain can range from mild to severe, and many Endo patients live with chronic pain daily.

Most women rely on over the counter remedies, such as acetaminophen (i.e. Tylenol, Excedrin), nonsteroidal anti-inflammatories (NSAIDs such as Advil and Motrin) and salicylates (aspirin). Others opt for natural remedies, such as herbs, biofeedback, acupuncture, exercise (which releases the body's own natural painkillers known as endorphins) and meditation. Still others rely on prescription narcotics for their pain relief, though many physicians are reluctant to prescribe such meds, for fear (often mistaken fear) of addiction.

The Women's Wellness Clinic at Stanford University Medical Center recently began conducting a study under the direction of Dr. Ellie Williams regarding possible new pain management medication for women suffering from debilitating pelvic pain, which may or may not be due to Endometriosis specifically. Their research shows that though the use of Selective Serotonin Reuptake Inhibitors (SSRIs) has been proven to reduce other sorts of chronic pain without the
harsh side effects of tricyclics, no study has ever applied the use of SSRIs to relieve pelvic pain. The ERC will elaborate on this approach further as study results and more information become available.

As with any form of therapy, a patient should consult with her physician regarding pain management. Certain risks apply to all medications and therapies. For those who take prescription or over the counter drugs, the University of Pittsburgh Medical Center discovered that in certain patients, taking 2 more pills than the label recommends of acetaminophen can seriously damage the liver. Another study conducted by Johns Hopkins University indicated that patients taking more than one acetaminophen tablet a day for one year virtually doubled their risk of kidney failure. As for NSAIDs, research shows that people who have taken approximately 5,000 pills in their lifetime have an 8.8 times higher risk of kidney failure than those who have
taken fewer than 1,000. Aspirin can cause allergic reactions in some patients, and can irritate the stomach lining causing bleeding, ulcers and nausea. If painkillers are taken regularly for too long a period of time, some patients may experience the "rebound" effect. When this happens, the person may experience that when the medicine wears off, the pain is worse than ever. And of course, it should be remembered that any form of pain relief is simply masking the real problem.

Many patients with chronic pain also suffer from depression, for many reasons. For instance, a person with with chronic pain often finds herself unable to participate in normal daily activities. Also, as Endo patients know, chronic pain patients sometimes appear to be well even though they are suffering. In addition, certain medications the patient might be taking to ease her pain may actually induce or enhance her depression. And finally, the chronic pain patient usually has a change in her brain chemistry which actually produces depression. A physician might prescribe an anti-depressant in an attempt to alleviate this by-product of chronic pain.

Some natural ways to ease pain, as relayed by women in the Endometriosis community are:

Exercise - daily exercise releases endorphins and can prevent pain from getting worse. Consult your physician to find an exercise regimen that works for you.

Meditation - get a mental grip on pain. Picture yourself physically removing the pain from your body. There are several books and materials available to help you master this art.

Acupuncture - this ancient Chinese therapy involves painless insertion of needles at key points in the body. It is said to release endorphins and block pain.

Massage therapy - this is said to be especially good for chronic pain of unknown origin. It can also help to clear out scar tissue or adhesions and cellular debris. Accupressure may be part of the massage, which is stimulating pressure points with fingertips and knuckles instead of needles.

Biofeedback - utilizes electronic devices which enable you to monitor and thereby control brain waves, blood pressure, and possibly, pain.

Ginger - a natural spice which helps relieve headaches and upset stomachs. Said to be especially good for patients with Irritable Bowel Syndrome.

Peppermint - also said to be helpful in aiding Irritable Bowel.

Fish - regularly including fish in your diet can help lessen the frequency of migraine headaches sometimes associated with PMS, and also is said to help prevent or relieve pain associated with osteoarthritis symptoms, as with
Fibromyalgia.

Black Cohosh, Wild Yam and Skullcap - have been said to relieve hormonally induced pain.

Vitamins B and E and calcium and magnesium - may help balance estrogen and prostaglandin levels and reduce menstrual cramping.

Following is a story from a woman the ERC spoke with regarding her own chronic pain situation and her suggestions for relief strategies:

"Murphy's" Story:
"Aside from the "usual" (Anaprox, Ponstel, Motrin, Advil, and Tylenol with Codeine), I used to take Tylenol PM (even in daytime) just to knock me out. I found sleep was the absolute best relief I could get, although not very convenient if you have to be somewhere like work or school!

I did find some relief in trying to stay calm. I used to really panic when I got the pain and would scream and cry, especially when I was younger. Then for a long time the BCP's made me feel so good I didn't mind a period at all. When they stopped working, that's when I began asking questions.

To keep myself calm, I usually would make sure I had something to read (love reading), whether it was a magazine, book, or both. But nothing too heavy that can make you feel worse. And because my system is like Big Ben, I always knew when I would be sick so I would save any TV shows I taped so I could watch that day. This way if I fell asleep I wouldn't miss anything."

Finding a doctor who specializes in Endo, who can help personalize a regimen that suits your own individual needs, is your best bet for pain management. For more information on natural and alternative pain therapies or for additional materials on this topic, please contact us. We are here to help any way we can.

*Disclaimer: please be advised that the information contained herein is based solely on publicly available research, and does not constitute medical advice in any form. Additionally, the ERC does not recommend nor endorse any physicians, medications, organizations, or treatment methods. Please consult your personal physician or other medical professional for treatments and diagnoses. Thank you.*

The Endometriosis Research Center
751 Park of Commerce Drive / Suite 130
Boca Raton, FL 33487
toll free - 800/239-7280
direct - 561/988-0767
fax - 561/995-7121
email - EndoFL@aol.com / EndoFL3@aol.com
URL - http://www.endocenter.org

Sources:
Alternative Health Guide
American Family Physician (51, 1:203)
The Journal of American Medicine (272,23:1845, 1866)
The New England Journal of Medicine (331,25:1675, 1711)
The National Pain Outreach Association: 7979 Old Georgetown Road, Suite 100,
Bethesda, Maryland 20814

(c) 1998 ERC
All rights reserved.