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Chronic pain – A unique experience that requires a unique treatment.

Chronic pain – A unique experience that requires a unique treatment.

Women diagnosed with endometriosis often have to endure extreme pain levels since their early teens. This pain reaches its peak around ovulation. Approximately 400 to 500 periods take place before menopause. Beside this chronic exposure to pain due to ovulation, many patients have to go through countless gynecological examinations and several operations. Still, the level of pain that is experienced by endometriosis varies from patient to patient.

The threshold of pain is the point when an individual starts to feel pain. This point is different for every individual and completely subjective. It's subjective because a pain threshold depends on ethnic backgrounds, sex, gender or genetics. Also the threshold can shift in time. Women who are diagnosed with endometriosis are exposed to pain frequently or even daily. This causes a threshold shift. Women diagnosed with endometriosis will get used to a certain pain level. A pain threshold will adjust itself to this experience.

The definition of chronic pain is pain that will last for longer than six months. When pain becomes chronic, this type of pain will no longer be a warning. It can become even dangerous because the individual who is coping with chronic pain will develop a so called pain tolerance. This tolerance will be the foundation of cognitive methods that helps the individual cope with chronic pain. Remarkable is that these cognitive methods only seem to apply to intense chronic pain. When an individual is exposed to minor pain after forming such cognitive methods, cells responsive to pain have a tendency to respond more powerful to minor stimuli. So if you as an endometriosis patient slightly overreact when you graze your skin or hurt yourself in a minor way, don't worry. It does not mean you are a wimp at all. It just shows your brilliant cognitive skills that only warriors have.

Women diagnosed with endometriosis can handle pain to extreme extends. Because they are exposed to pain on a regular basis it will increase their pain tolerance. By becoming more conditioned to pain, pain can be handled to extreme levels. For example, last year I broke my pinky on New Year's Eve. Somehow in a silly movement my pinky got stuck in a pocket on the bag I threw on my bed. I flinched, but it never occurred to me it could actually be broken. My family was worried about my finger that looked broken. But because I was able to cope with the pain and we were about to start a festive dinner, I didn't want to be a party wrecker. Besides, I see the local hospital too many times already due to endometriosis. Six weeks later I went to my doctor because my pinky still hurt a little. He send me to the hospital and an x-ray showed that I had a mallet finger. Everybody in the ER but me was shocked that I walked around with a broken finger for six weeks. I actually remember making a mental note, telling myself to remember this feeling because this is what it feels like when something is broken.

Because the experience of pain is entirely subjective, pain levels as described by a patient can not be used to determine a certain stage of endometriosis. Sometimes a woman experiences little pain while surgery shows much endometriosis or vice versa. Although this experience is subjective it is of great importance to know the background of a patient when treating endometriosis. Because the  psychological aspects of this disease are different for every patient. Every case is unique and therefore needs a treatment specifically designed for one individual. Important to know is how someone copes with chronic pain and the changes in someone's lifestyle due to endometriosis. It affects a womans life in so many ways. All these aspects have to be taken into account when treating endometriosis. When endometriosis is treated in this way the quality of life will also be secured and can (when possible) be improved. This is why Dr. Seckin believes it is so important to know a patient before surgery. To know how a woman is dealing with this disease and how it affects her life. He once told me that if he would not take this into account he could just as well operate on a piece of wood. This is why many times his patients will also be seen by a psychologist. Such a session does not need to last for hours. It will be used for a solid foundation of the treatment that has to be designed for a specific individual. Over all it is of great importance that a surgeon takes psychological aspects into account.  

Every woman is shaped by different experiences which makes chronic pain a multidimensional given. The brain constantly negotiates with chronic pain and defines unique cognitive methods that allows a patient to cope with the well known killer cramps. All domains in a woman's life are coloured in a certain way, which is different for every individual. Because pain is being influenced by many psychological aspects, a treatment that fits like a glove will only be accomplished when taking all these aspects into account.

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