Chronic Pain in the Young: Pelvic Pain, Etiology

By | March 23, 2012


Endometriosis is a condition where tissue resembling the lining of the uterus is found on abdominal organs and the peritoneum. The problem is that not all pelvic pain is endometrial in origin and not all endometriosis is painful.

If I had to pick a chronic pain condition afflicting the young that was particularly poorly understood and treated, chronic pelvic pain would be near the top of the list. I am not talking about the simple cases such as ovarian cysts or pelvic infections, but rather of the pain conditions that tend to persist for years without a satisfactory diagnosis. While usually ascribed to endometriosis, I wonder whether endometriosis isn’t a coexisting condition rather than a causative factor, much like cervical arthritis and occipital neuralgia. I say this because as an anesthesiologist I saw many laparoscopies for pelvic pain where there was little or no endometriosis and nearly as many laparoscopies done for reasons other than pain with extensive endometriosis. Furthermore at Schlesinger Pain Centers we have seen many patients who have been successfully treated for their endometriosis, yet continue to have pelvic pain, which is unchanged. In my experience treating chronic pain in the young most of the really severe pelvic pain cases turn out to have significant autonomic and neuropathic pain components, making their diagnosis and treatment among the most interesting that I see.

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