Let’s face it – pain is unpleasant and no one wants to experience pain. Some pain, however, is good in that it protects us from damage to our body. Without a pain mechanism, we would be vulnerable to damaging our body, which could even be life-threatening.
The “good type of pain” that protects us from injury is known medically as nociceptive pain. Nociceptors arethe little nerve endings that sense pressure and pain. Nociceptive pain is a message that our bodies are being exposed to something harmful and that we should remove ourselves from the source of pain. In the case of endometriosis and other causes of pelvic pain, we need to listen to our bodies. It is not right to have this much pain. Once the source of pain is removed, for example by the excision of endometriosis, the nociceptive pain subsides.
The other kind of pain is “bad pain” – the patient experiences pain even though there is no damage or injury occurring to the body. The medical term for this type of pain is neuropathic pain. There are two subtypes of neuropathic pain: peripheral neuropathic pain and centralized neuropathic pain.
Peripheral neuropathic pain usually involves a specific location or extremity. An example of this is if you crush your finger and it becomes tender to the touch, even after it heals. Over time, chronic pelvic pain can develop a neuropathic component, which is one reason surgery does not always resolve endometriosis pain.
The centralization of pain can be compared to turning up the volume on the nervous system. If you are listening to some pleasant music and the kids run by and turn up the volume all the way, what was pleasant becomes painful, even though it is the same music. The intensity of the signal is just too great, and your entire body hurts. Fibromyalgia is a type of centralized neuropathic pain.
Identification and treatment of both nociceptive and neuropathic pain is needed for comprehensive pain management. Treatment of nociceptive pain usually resolves the pain, whereas treatment of neuropathic pain is focused on managing and reducing pain to a tolerable level.
Also, the intensity and duration of nociceptive pain are risk factors for developing neuropathic pain. In other words, the more severe the pain and the longer the nociceptive pain is present, the more likely neuropathic pain will develop. This is one reason it is important to have the endometriosis and pelvic pain treated effectively and in a timely manner.