13 Questions
What is a consequence of using narcotic analgesics for chronic pelvic pain?
Sensitisation of nerve pathways, worsening chronic pain
Why should narcotic analgesics be avoided in chronic pelvic pain management?
They are highly addictive and can worsen pain
What is a strategy for managing pain while minimising the use of narcotic analgesics?
Engaging in activities with strong personal motivating factors
What type of pain is narcotic analgesics often relatively ineffective in treating?
Neuropathic pain and pelvic muscle spasm
What is a consequence of reducing the dose of narcotics after prolonged use?
Return of original pain levels, with added dependence
What is a characteristic of central sensitisation?
Normal sensations are felt as painful
What is an example of hyperalgesia?
Painful sensations becoming more painful
What is a potential side effect of exercising too much with central sensitisation?
More pain the next day
What is the purpose of explaining the physical changes in nerve pathways to patients?
To help them understand that substantial improvement is possible
What is a recommended starting dose of amitriptyline?
5 mg three hours before bed
Why should Pilates-style core-strength exercises be avoided?
They may aggravate pelvic muscle pain
What is a recommended type of exercise for pain management?
Walking, dancing, or gentle team sports
Why is regular exercise considered essential for pain management?
It is the best non-drug treatment for pain
Study Notes
Central Sensitisation
- Central sensitisation is a chronic pain condition that affects chronic back pain, postinjury pain, and pelvic pain.
- It is essential to manage this condition, especially when pain is present on most days.
Characteristics of Central Sensitisation
- Normal sensations felt as pain (allodynia)
- Painful sensations becoming more painful (hyperalgesia)
- Pain felt over a larger area when severe (wind-up pain)
- Poor sleep, fatigue, anxiety, and low mood
- Nausea, dizziness, or sweating
Treatment of Central Sensitisation
- Explanation of the physical change and sensitization of nerve pathways
- Use of neuropathic medications, such as:
- Low-dose amitriptyline (5-25 mg daily)
- Pregabalin (25-300 mg daily)
- Duloxetine (30-60 mg daily)
- Regular exercise, which is considered essential for pain management
- Activities with strong personal motivating factors, such as playing with children, sport, or craft
Exercise Considerations
- Start with a 10-minute walk daily and increase slowly
- Avoid too much exercise suddenly, which can result in more pain the next day
- Avoid Pilates-style core-strength exercises until pain improves
- Prefer exercises like walking, dancing, or gentle team sports
Avoiding Dependence
- Avoid narcotic analgesics due to high risk of dependence and potential to worsen chronic pain
- Narcotics are often relatively ineffective in neuropathic and pelvic muscle spasm pain
- Reducing the dose of narcotics later is difficult
Learn about central sensitisation, a chronic pain condition where normal sensations are felt as pain. Understand how to manage chronic back pain, postinjury pain, and pelvic pain. Discover the symptoms of allodynia, hyperalgesia, and wind-up pain.
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