In her recent presentation at Pain Week 2017, in Las Vegas, Nevada, *Dr Kathryn Witzeman, MD, FACOG noted that “CPP in itself is not a diagnosis but a symptom. When Clinicians focus on the symptoms they are also focusing the patient on “pain” and the treatment of pain instead of what is actually contributing to their experience. When we are focusing on anticipating pain, we have low self-efficacy which can lead to depression and negative habits. Rather than treating symptoms conventionally doctors could incorporate integrative modalities for the treatment of female chronic pelvic pain”
Traditional medical and surgical treatments for CPP have been known to exacerbate the symptoms. Hormonal treatments influence the body’s natural ability to process pain; Pain killers can cause sleep dysfunction. Adequate sleep is important because it promotes improved immune function and even has pain relieving effects.
CPP is a composite of chronic and recurrent pelvic pain. It can be constant or intermittent, cyclical such as during menstruation or non-cyclical (due to endometriosis and adhesions) or deep (pain during sexual intercourse) and many women experience overlapping symptoms such as IBS
Some modalities which can be integrated into a conventional approach are:-
- Cognitive Behaviour Therapy –helps change maladaptive, or harmful, thinking. Therapists use techniques to help patients break negative patterns and beliefs about their ability to feel well and replace them with more realistic and effective thoughts. This can help decrease emotional stress and self-defeating behaviors, which can worsen pelvic tension and pain.
- Mindfulness Base Stress Reduction. Mindfulness teaches a person how to be aware of their thoughts and to choose their attitude towards their condition; Focusing on what they can do rather than limiting beliefs.
- Hypnosis – has consistently been shown to reduce pain in a variety of chronic pain conditions; it has demonstrated efficacy in treating irritable bowel syndrome (IBS) and improving quality of life in patients. Self-Hypnosis allows the person to utilize several tools to dissociate, visualize their pain as something else, to turn pain off, and/or reduce it. Additionally hypnosis elicits the release of endorphins which are the body’s natural pain killers.
- Yoga – Practicing yoga has shown numerous benefits in various chronic painful conditions. It’s something that is empowering because the patient can do it to self-treat if they are having flare ups.While a growing body of research shows that exercise in general is beneficial to those dealing with chronic pain, in yoga there are major benefits that could be applied specifically to pelvic pain.Generally, those in pain tend to breathe more shallowly, therefore, the primary benefit of practicing yoga is the “pranayama” or deep breath work that is a fundamental tenant in any yoga practice. This is because it promotes relaxation by increasing the flow of oxygen to organs of the body and releases our body’s natural analgesic, endorphins.
- Breathing and other relaxation techniques – when we breathe deep and slow our autonomic nervous system gets the message that all is well and releases endorphins which allows all the systems of our mind and body to work in perfect harmony which promotes healing.
- Aromatherapy – involves massaging with essential oils (EOs); They reduce stress and boost our mood, ease muscle tension and relieve pain.EOs have been used for thousands of years in religious rituals and medical applications; in fact, EOs are mentioned multiple times in the Bible and have long been a staple of Ayurveda (a form of Eastern medicine). Before we had Tylenol and Advil, we had EOs. The strange thing is that many modern medicines are made to mimic or replicate the effects of EOs.
Read more articles from Pain Week 2017 here
*Dr Kathryn Witzeman, MD, FACOG is Associate professor at the University of Colorado in Denver and director of the Women’s Integrated Pelvic Health Program at Denver Health Medical Center