#38. Women and pelvic pain: A big pain problem below the waist

Marina, another patient of mine, was the executive assistant for a Member of Parliament, 28 years old, happily married and pregnant with her second child. However, this pregnancy was complicated and the doctors used “vacuum suction” to help the baby come out. Unfortunately, too much suction was applied that created huge damage in Marina’s uterus and bladder, giving her between other things immense pain and inability to control her urine (as the bladder had been damaged). Her ordeal was long with numerous procedures to repair the torn tissues, multiple medications and even implantation of a sacral nerve stimulator, an electrical device to power the opening of her bladder, to help her hold her urine – which failed. When I saw her, the previously happy woman had turned into a shadow of herself: she was extremely depressed, had put on a fair amount of weight, she could not sleep, the medications made her vomit all the time, and on the top of all this, she hurt constantly. Our thorough investigations showed that this unfortunate woman not only had damaged several inner organs (one of the causes of her pain), but the injury had also affected the nerves that supply these organs and in turn her whole nervous system (the spinal cord and the brain). In other words, she had two kinds of pain, nociceptive visceral pain and neuropathic pain (for more information on this type of pain, please refer to the very first column I wrote for CARP Action Online). Christina had chronic pain that started with her periods and evolved to chronic unremitting pelvic pain, influenced mainly by stress and emotional turmoil. Marina sustained serious internal damage and ended up with both visceral nociceptive pain and neuropathic pain, both of which were made worse by her depression. For Christina a multidisciplinary pain program, in which specialists work together to address pain from both the physical and the psychological point of view, worked better. Marina’s pain came under control only when her psychiatrist attacked her depression with a combination of antidepressants and counseling. Once she managed to accept her limitations, she was able to ask herself: “How do I make the best of what I have?” She continues to be on medications and needs ongoing counseling for support, however, she has managed to capture some good quality of life and be a good mother to her beautiful children. In regards to treatments, the best bet for the sufferers is referral to a multidisciplinary pain clinic (preferably within hospitals affiliated with universities). It is hoped that pelvic pain as well as any other kind of complex chronic pain diagnosis and management, will improve as provinces and our country as a whole slowly moves towards a comprehensive pain strategy.

Angela Mailis Gagnon, MD, MSc, FRCPC(PhysMed)
Director, Comprehensive Pain Program,
Senior Investigator, Krembil Neuroscience Centre
Toronto Western Hospital,
www.drangelamailis.com
Chair ACTION Ontario www.actionontario.ca

These topics are also covered in Dr. Mailis Gagnon’s book: Beyond Pain: Making the Mind-Body Connection

Keywords: pain, costs, treatment