Page 245 Guide to Pain Management in Low-Resource Settings

Dysmenorrhea, Pelvic Pain, and Endometriosis 233

It is therefore important to explain to the patient • Many common causes of pelvic pain cannot be
and her family: seen during an operation, including bladder pain,
• Th e pain is real, and the pain is not her fault. neuropathic pain, uterine pain, pelvic fl oor mus-
• She does not have cancer, and her pain is not life- cle pain, and bowel pain. Some women have en-
threatening. dometriosis and all these other pains. Migraine
• Although it may not be possible to completely headaches are also common.
cure all her pain, she can optimistically look for- • Women with chronic pain who appear “worn
ward to less pain and living better with what pain down” emotionally or depressed often have a
remains. It is important to be positive. neuropathic component to their pain. Th is will be
• Resources she can contact if she needs help. worse if the patient is stressed or overworked.
• What extra pain relief she can use if the pain be- • Recognize that many women have had pain for
comes more severe; her anxiety will decrease long periods of time, resulting in loss of confi -
when she knows that she can manage pain if it dence, employment and education opportunities,
occurs. relationships, and sometimes fertility.
• To ensure that she is not overworked, because • It is important that the patient’s family value her
tiredness will worsen her pain. health and happiness, and that she has activities
• To ensure that she has activities in her life that in her life that bring her joy, relaxation, and satis-
she enjoys. faction. “Fit, happy people have less pain.”
• Recognize that while surgery can be very helpful,
What should I ask it does not cure all pain. Th e decision whether to
at follow-up visits? proceed to surgery or use nonsurgical treatment
will depend on the surgical facilities available.
Follow-up assessments are important because the pain • Be careful to explain the pain to the patient and
will vary over time, and the patient will need continued make sure she knows that you believe in her pain.
support to be well. At each follow-up: Most women with this type of pain have been
• Ask about each of the pains she reported at her told that “it is all in their head,” which lowers their
fi rst visit to assess progress. Pain that has been self-esteem.
resolved is often forgotten. She may feel that no • Make sure that the family knows that the pain is
progress has been made if any pains remain. real. Th e patient will need the support of her fam-
• Ask about any new pains. Ask about sexual func- ily to access care.
tion. Off er treatment for any new pains.
• Discuss lifestyle issues again, such as regular ex- References
ercise, healthy diet, stress management, relation-
ship issues, and activities that she enjoys. [1] Evans S. Endometriosis and pelvic pain. Available from: www.drsusane-
vans.com. (An easy-to-read book for patients that explains how to diag-
• Make sure she understands that her pain may nose and treat many types of pelvic pain.)
[2] Howard FM. Pelvic pain: diagnosis and management. Lippincott Wil-
change over time but that help is available if she liams and Wilkins; 2000. (A textbook for doctors describing all aspects
needs it. of pelvic pain in detail.)
[3] Stein A. Heal pelvic pain. Available from: www.healpelvicpain.com. (A
book for patients with all types of musculoskeletal pelvic pain.)
Pearls of wisdom
Websites
• Most women with chronic pelvic pain have sever-
al diff erent pain symptoms. Each pain needs to be www.endometriosis.org (world forum for patients and doctors)
assessed, and a treatment plan made. Pelvic pain www.endometriosisnz.org.nz (for teenagers with endometriosis)
cannot be considered as a single entity. www.ic-network.com (for bladder symptom information)