Peritoneal Endometriosis and Pain Q&A

As part of Endometriosis Awareness Month, the Endometriosis Foundation of America (EndoFound) and My Endometriosis Team are organizing a series of endometriosis community conversations. On March 14, journalist and endometriosis patient advocate Diana Falzone hosted a live Q&A session with Dr. Dan Martin, EndoFound’s scientific and medical director about peritoneal endometriosis and pain.

Dr. Dan Martin’s passion for endometriosis

Dr. Dan Martin is a retired physician and a Professor Emeritus at the School of Medicine, University of Tennessee Health Science Center. Dr. Martin started studying endometriosis as early as the 1970s and has published many research papers on the subject since 1983.

Those were the times when the field of endometriosis started seeing many advances including the first demonstration of laparoscopic hysterectomy by Dr. Harry Reich. However, it was also the time when there was still a wide prevalence of misinformation about fertility and pain.

“In the 70s, endometriosis was seen more as a disease for infertility than it was for pain”, Dr. Martin said.

Dr. Martin’s physics background helped him devise innovative techniques such as using lasers in surgery for the precise excision of lesions. He now serves as EndoFound’s scientific and medical director.

Cause for debilitating endometriosis pain

Dr. Martin talked about several theories on the cause of endometriosis. Nineteen of these appear on his website four of which explain the first cell of origin of the disease. These primarily include retrograde menstruation, congenital rest, peritoneal metaplasia, and disseminated bone marrow stem cells.

“Endometriosis can produce prostaglandins that cause contractions and cramping”, Dr. Martin said.

Estrogen or inflammation then activates the first cell and turns it into endometriosis lesions that are resistant to progesterone. These lesions lead to fibrosis that causes pain.

Tips for managing joint pain resulting from endometriosis treatment

Talking about why endometriosis treatment can cause joint pain, Dr. Martin said that the medications could stop estrogen production, which in turn affects bone health causing joint pains. Other possible reasons could be endometriosis being associated with rheumatoid arthritis, posture imbalance, and other sources of pain.

“I had about three patients who had significant knee joint pain related to a GnRH agonist, and it took some of those up to six months for the pain to go away even after stopping the medication”, Dr. Martin said.

Treating pain with non-steroidal anti-inflammatory drugs, diet, and exercise are some of the ways in which doctors can help patients deal with joint pains. Usually, stopping the medication that is causing the pain will work, Dr. Martin said.

Effect of diet and exercise in reducing endometriosis pain

Dr. Martin went on to explain how diet and exercise could possibly help. Diet can alter inflammation patterns and change the natural biome in the body. Switching to an anti-inflammatory diet can prevent body reactions to food such as gluten, dairy, and refined sugars, which can trigger inflammation and pain.

“If you are in pain long enough, your mind gets used to being in pain and will interpret it even when there’s no source of pain,” Dr. Martin said.

Physical therapy and exercise that work on joints can also be helpful in correcting muscle and ligament movement, stretching them adequately, and relieving the pain, Dr. Martin explained. However, the effects of such therapies often take time and it’s important to trust your physical therapist on this.

Taking care of pain at home and when to see the doctor

While understanding the exact nature of pain will require a proper diagnosis, it makes sense to first look up tips on dealing with pain online. It is easy to get access to many resources that deal with pain relaxation, self-help guidelines, and more.

“All of them (online pain resources) worked for somebody otherwise they wouldn’t have been written and some of them may work for you”, Dr. Martin said.

Though pain is hard to quantify, Dr. Martin said that it should not interfere with daily activities. If pain is interfering with daily activities, work, or school, that’s not normal pain, and you should consult your doctor as soon as possible.

Key takeaways related to pain management and endometriosis

Killer cramps are not normal as they can interfere with normal body function and can cause stress-related changes such as inflammation, neuroimmune modulation, and body dysfunction. Initial treatment with anti-inflammatory agents and hormonal suppression can control pain, decrease activation of endometriosis, and decrease the chances of central sensitization.

Timely intervention in the early stages may help stop the progression of endometriosis. In late stages, it may help avoid surgery or at least get a better result from it.

“We know [about endometriosis] a lot more than [what] we knew 40 years ago. What I want is some way to stop it from occurring”, Dr. Martin said.

Though endometriosis pain can be debilitating, it does point towards the existence of the disease unlike conditions such as silent endometriosis where the disease remains latent until more serious symptoms such as recurrent miscarriages or infertility are noticed.

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