The Story Behind Pelvic Answers and Dr. Butrick
Pelvic pain affects 15-20% of all women in the United States. The majority suffer in silence or attempt to get care from a physician that does not specialize in pelvic pain. 40% of all laparoscopies done by a gynecologist are for the evaluation of pelvic pain yet for the majority of those patients the pain does not originate from the female organs. Hysterectomies are done on a regular basis for pelvic pain, but the pain will persist in approximately half of those patients. Further, all surgeries have the potential to trigger new pain or a persistence of pain in at least 20% of patients.
Much has been learned about why people have chronic pain. While it is often triggered by disorders like endometriosis, interstitial cystitis, irritable bowel disease, fibroids or musculoskeletal injuries we have learned that when pain has been present for several months, no matter where the original pain started, it can trigger a chain of events that results in nerves in the spinal cord and the brain becoming hypersensitive. These changes result in what we call centralized pain. At this point, while the pain possibly started with a single source (pain generator), patients often develop new problems of pain from other areas in their pelvis as well as areas outside their pelvis. A provider who is trained in understanding the importance of evaluation, identification and treatment of each of the patient’s pain generators will provide that patient the best opportunity for resolution of her pain. While surgery to remove a trigger or cause of pain is sometimes required, that surgery typically must be accompanied by the management of the pain disorder itself.
Dr. Butrick was one of the founding members of the International Pelvic Pain Society (www.pelvicpain.org). This society is made up of providers from multiple backgrounds and training who dedicate their practice to the evaluation and treatment of patients with pelvic pain. Their website is filled with excellent information as well as a provider finder function to help patients find a provider that specializes in pelvic pain in their area.
Pelvic pain, like all kinds of pain anywhere in your body, is always easiest to take care of and resolve when it has not been present for several years. I encourage all patients to be pro-active concerning the management of pain. A surgical intervention will always be more successful when done in a timely fashion but remember most chronic pain disorders do not respond to a surgical procedure alone. Finally, the opioid crisis has taught us many things about proper management of chronic pain. Narcotics should be of avoided if possible because we now understand that patients who take narcotics are much more likely to have persistent pain and getting off narcotics will become increasingly difficult because the narcotics make the nerves within the central nervous system more hypersensitive in the long run. There are many other pharmacologic therapies that generally work better than narcotics especially when a provider targets the medication towards the actual cause for the pain. Determining if the pain is neurologic (related to nerves) or related to muscles will often guide us in what kind of medications would provide the most benefit. Narcotics are rarely a good choice.
One of most important discoveries in the field of chronic pelvic pain is that the majority of patients have at least a component of their pain coming from their pelvic floor muscles. Those muscles (as a response to any generator of pain or as a result of an injury or prior surgery) can become overly tight, painful as well as spastic. This not only affects the function of your pelvic organs but is one of the main contributors to chronic pain. Treating those muscles has therefore been a major breakthrough in the management of chronic pelvic pain. Treatment often involves physical therapy, medications and even the use of Botox. Dr. Butrick was involved in the development of the newest therapy for this pelvic floor muscle pain which is called SoLá Therapy (www.solatherapy.com). This new therapy has demonstrated that all types of pelvic pain will show improvement in at least 70% of patients and two thirds of those will have minimal or total resolution of their pain after 9 simple office-based procedures. This new therapy has demonstrated pain relief for at least 6-12 months. Adjunctive therapies such as behavior modification, low inflammatory diet, mindfulness training as well as a continuation of physical therapy directed muscle exercises are all quite successful at keeping patients pain free for years to come. But the key is to find a provider that specializes in pelvic pain. Every patient deserves a life without pain.