Exceptional Care – Avoiding Bad Care: Pelvic Pain Case, Part 3

By | June 26, 2011

In retrospect it is likely that E. A. was suffering with endometriosis and not from it. I have seen many similar cases and now feel that endometriosis pain is a misnomer and that endometriosis is often a marker for pelvic pain as opposed to a cause of it. We do not know what causes this syndrome, but as in the present case most cases of pelvic pain seem to be mediated through autonomic nerves and ganglia. This simple fact has led us to a number of useful diagnostic and treatment options.


I have told E.A. that while I am pleased with her progress I am not sure that we will be able to produce complete and lasting results with these Superior Hypogastric Blocks alone. Furthermore, there are the issues of ongoing radiation exposure and potential nerve damage, both due to the repeated insertion of the needles in a very crowded part of the anatomy. There are times when the seemingly most radical solution turns out to be the most conservative.


I suggested that we try a few more blocks, but that if the pace of progress does not pick up, we should begin a trial of spinal cord stimulation. If neuromodulation were to be effective, we might be able to resolve the entire problem with an extended (2 weeks) trial of spinal cord stimulation. I have seen chronic pain cases, which have responded to short, but intense periods of spinal cord stimulation and even if permanent implantation proved necessary there are many reports of spinal cord stimulators being turned of and even removed after a period of months to years.


E. and her mother both agreed that this was a reasonable plan and said that they would consider a trial by the end of the summer or early fall. I told them that fall was fine, because she would not be able to shower for the period of the trial. While two weeks of sponge baths is possible even in summer, the cooler weather might make the trial more pleasant.


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