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Article by WNDU

More than six million American women and girls struggle with endometriosis, a chronic condition that causes pain before and after their periods. It can also cause infertility. In some cases, endometriosis is difficult to diagnose, but a new imaging method may shed light on difficult to detect cases.

Twenty-eight year old Susie Veech has spent more than half her life in the kitchen. She’s a food service consultant and a budding caterer.

Susie also spent more than half her life trying to figure out the source of the monthly, searing pain in her side. Veech told Ivanhoe, “Eleven, on a scale of one to 10, the pain.”

Veech had endometriosis. The tissue normally lining the inside of her uterus was also growing on the outside and blocking other organs.

Gynecologist and co-director of the Endometriosis Center and the Minimally Invasive Surgical fellowship program at Mercy Medical Center in Baltimore, Kevin Audlin, MD, is studying a new imaging technique designed to help gynecologists detect endometriosis. Traditionally, doctors use a minimally-invasive tool called a laparoscope to look for tissue.

“Full spectrum light looks just as if we would see. If you’re looking into a belly, you’ll see organs, most everything is either a yellowish or a pink,” Dr. Audlin explained.

In addition, Dr. Audlin is testing special lighting called narrow band imaging. When he presses a button on the laparoscope, the light changes, making endometriosis stand out.

Dr. Audlin said, “The red hue tends to be the endometriosis, the green we see tends to be the actual vasculature.”

For Veech, finally a diagnosis followed by a procedure to keep the endometriosis at bay. She said, “When everyday pain goes away, you have tons of energy. You don’t realize how much it’s weighing you down.”

In a study of 150 women undergoing the laparoscopic procedure for endometriosis, researchers found the addition of narrow band imaging improved detection by 20 percent. Dr. Audlin says the narrow band imaging offers another avenue for women who have had chronic pain but are not showing signs of endometriosis with traditional screening.

To read the research summary, click here.

 

Chronic Pain Linked to Attention-Deficit Disorder

ADHD word Attention Deficit Hyperactivity Disorder on magnifying glass and human brain on white background

By Pauline Anderson via Medscape

September 11, 2015

LAS VEGAS — More than a third of patients with chronic pain may have attention-deficit disorder (ADD), a small pilot study suggests.

The findings should encourage more doctors to have a high degree of suspicion of ADD in nonadherent patients with central pain, said author Forest Tennant, MD, Intractable Pain Management, West Covina, California.

“I think this is a nice new little advance in how to take care of people with pain.”  He presented the findings here during PAINWeek 2015.

For the study, 45 consecutive patients with chronic pain attending a treatment clinic completed a 16-item questionnaire. The questions were directed at whether the patient had deficiencies in concentration, attention, distractibility, impulsivity, reading and retention, coordination, temper, and short-term memory.

A positive answer to five or more questions was considered to indicate the presence of ADD.

Results showed that 37.8% of the patients met these criteria for ADD.
Most patients with centralized pain have hyperarousal of the autonomic nervous system. “First off, they become deficient in catecholamine, which is one of the compounds that relieve pain,” explained Dr Tennant.

The pain causes a change in the sympathetic nervous system, which causes the ADD, he added. “So it puts you into this hyperactive state and at times it will also deplete dopamine both in the central nervous system and in the adrenal gland.”

The finding might help explain why some patients with pain have poor function in activities of daily living, said Dr Tennant.

“For years, I’ve seen the same kind of ADD in these patients that you see in children; they can’t remember half the time, they can’t concentrate,” he said. “It’s amazing how many of these patients actually quit reading or doing things, but they won’t tell you.”

A big problem for patients with pain is adherence issues, said Dr Tennant. “They don’t do what you tell them; they walk out of there and don’t follow instructions, and part of that is ADD.”

But once they start taking drugs for ADD, such as methylphenidate (eg, Ritalin), “their pain gets better and they can remember and concentrate.”
Dr Tennant stressed that this applies only to patients with centralized pain, who have inflammation in the nervous system, not those with arthritis or neuropathic pain. “These are the patients who have constant pain, pain that never goes away.”

He noted that the connection between pain and ADD is not new. “Physicians back in 1895 at hospitals in London said that if you have severe pain patients who need morphine, they also need a stimulant.”

Commenting on the study for Medscape Medical News, Jack LeFrock, MD, a pain specialist at Above and Beyond Pain Management and Laser Center, Clearwater, Florida, said the finding “makes sense.”

“I agree with him; I think he’s right on,” he said.

In his own practice, a “high percentage” of patients have ADD and are anxious, he added.

Dr LeFrock said he’s keen to study the topic further.

PAINWeek 2015. Poster 133. Presented September 10, 2015.

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By Philippa Bridge-Cook, PhD

The alarming text came to my phone on a Friday afternoon: “I want to die.” It was from a friend with endometriosis who was suffering with intense pain again, and feeling like the continual suffering was unbearable. That text led to a visit to the ER, which ended up resulting in a three day hospital stay in a short stay mental health unit. Unfortunately, not much has changed: the cycle of pain continues, and my friend remains uncertain of how to cope with the severe pain which is sure to come again.

Sadly, this was not the first incident of severe depression and suicidal thoughts that I have been aware of associated with endometriosis. In the past month alone, throughout our support network I am aware of four other instances where people expressed suicidal thoughts and wanting to die because of the despair and hopelessness of dealing with pain that most people do not understand. And many people with endometriosis continue to suffer in severe pain despite medical treatment, so it can be particularly difficult to be hopeful for a better future.

Chronic pain from any cause has been shown to be associated with depression. This is not a surprising finding, as anyone who has lived with pain for any significant amount of time will know that the social isolation, inability to participate in normal activities of daily life, and sheer exhaustion, can lead to feelings of depression and hopelessness. Patients with chronic pain have a two to five fold increased risk for developing depression, and each condition affects the other: depression can worsen the perception of pain, and pain can worsen depression. Furthermore, studies have shown that when pain is moderate to severe, impairs daily functioning, and is difficult to treat, it is associated with worse depressive symptoms and outcomes.

Continue reading this article here: http://www.hormonesmatter.com/endometriosis