Pain Management Strategies and Alternative Therapies

This chapter discusses various modalities of endometriosis-related pain management with consideration of possible pain mechanisms explaining peripheral generators, central sensitization and neuropathic pain as well as myofascial and viscero-visceral and viscero-somatic hyperalgesia. The important role of the pelvic floor and abdominal wall in self-perpetuating this pain has been explored. It is evident that the complexity and the multifocal nature of this pain warrants a multidisciplinary (MDT) interprofessional approach to the management with a team of expert gynecologist, pain medicine specialist (with expertise in pelvic pain), pelvic physical therapist and clinical psychologist at minimum, with input from urology and gastroenterology specialists. This reflects the significance of multimodal treatments and chronic condition approaches to this multifaceted pain in contrast to unimodal treatments whether surgical or nonsurgical. A variety of management approaches are discussed, including pharmacotherapy, interventional injections, neuromodulation, psychology interventions and self-management and support. The chapter includes a useful number of references for further reading on individual aspects of endometriosis-related pain.