International Adhesions Society





A Patient's Guide to Adhesions & Related Pain (part 8)

Treatment of Chronic Pain

A full discussion of this subject is outside the scope of this article and I would recommend visiting the World Congress on Pain, International Pelvic Pain Society and the Endometriosis Society for more information.  The American Society for Reproductive Medicine has an excellent booklet on pelvic pain which is worth reading.  The first step towards treatment is of course diagnosis, and your doctor will take a history, examine you and possibly conduct some tests, in an attempt to determine the cause of pain.  These tests may include a laparoscopy.

In limiting my remarks to patients in whom ADHESIONS are believed to be the cause of pain, I will start out by saying that there are no easy answers.  There may not be a cure for the pain, but it may be controlled to a more acceptable level.  For reasons stated above, adhesiolysis may not be the answer and may not even be the first choice.  I would certainly ask your doctor if s/he might consider an adhesiolysis.  If s/he was able to use an ADHESION barrier, s/he needs to read the product label to determine whether it is appropriate.  If extensive adhesiolysis surgery is required, often a general surgeon will be (and should be) asked to collaborate with the gynecological surgeon.  Pain mapping is an emerging technique where, under local anesthetic, the surgeon attempts to locate the focus of pain by prodding different areas within the pelvis. Sometimes pain is associated with adhesions, and sometimes adhesions (or even loci of endometriosis) do not appear responsible for the pain.  If an endometriosis site is discovered and removed, this should be covered with an adhesion barrier.

I would also seek the counsel of a pelvic pain specialist who may suggest other treatments including trigger point injections, neuroablative procedures (where certain nerves from the 'source' of the pain are cut) as well as drug treatments, physical therapy, exercise and dietary changes.  In extreme cases where bowel function is disturbed, comprehensive nutritional support is a necessity.

Dr. C. Paul Perry has pointed out:

"It is very important that we have realistic expectations when dealing with chronic pelvic pain. The pain has occurred over a long period of time and will not go away in a short period of time.  Your recovery will be a process.  Many modes of therapy will be used over the course of your treatment."

The treatment of chronic pelvic pain is emerging as a multidisciplinary specialty.  A team of nurses, psychotherapists, physical therapists, pain specialists, anesthesiologists, urologists, gynecologists and general surgeons working in a coordinated manner can mean maximum benefit for the patient.  Not only is the problem of pelvic pain is receiving the attention is deserves, but the team approach to its management is being recognized as one with merit, as a recent conference attests.

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