The 90 Minute Checkup

The case of mind-body medicine.

Pelvic Pain: The Bare Truth

The mind-body connection in acute and chronic pelvic pain.

 

Chronic pain is something doctors and patients deal with on a daily basis. With the current trends of prescription pain medication addictions and definitive abuse, I wanted to share with you a story to highlight how medications are not the best treatment. True connection between a patient and doctor is imperative in helping with chronic pelvic pain and a 90 minute visit could help in getting to the cause.

I was in clinic one day when I received a call from a physician working in the local emergency room. “Shawn, I have a woman over here who is in excruciating pain and I was wondering if I could send her to your office?” I was taken aback because we usually send patients to the ER not the other way around. He then told me that she was having issues with debilitating pelvic pain and they had run every test imaginable; CAT of the pelvis, Pelvic ultrasound, Vaginal cultures, Urine cultures, and the proverbial cocktail of blood work. They gave her some pain medication which gave her some relief, but she was still having pain; all the test showed absolutely nothing organic.

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Not sure what I was going to do with the patient I agreed to see her. About 30 minutes later my medical assistant called her name and brought back to one of our exam rooms. The patient was hunched over into an ambulatory fetal-position and her steps were taken with thoughtful care. I walked into the room behind her and helped her to the table. The look of anguish on her face was completely disarming. I sat in a chair across from her and began taking a history. She claimed the pain came on as a thunderclap about two weeks ago and since that time she has had this unrelenting course and has been unable to leave her house; with this she began to cry.

In my clinical mind I was going through the medical and surgical management when I glanced behind her and saw a tapestry I have hanging on my wall that represents the Seven Chakras, or energetic centers of Ayurvedic Medicine. The First or Root Chakra being the pelvis and sacrum represents connection to family and relationships. Looking at this I was struck by the fact that she was describing a pain or blockage in this first chakra so I asked her a question, “Have you had any issues in the last few weeks with regards to relationships or family?”

Her crying immediately ceased and she looked up. Very sharply she stated, “Well two weeks ago my husband told me he was having an affair!”

“Well” I said “It’s easy to understand when we have stress that we might get migraines. You were hurt by an intimate relationship so maybe this is simply a migraine in your pelvis.”

She then finished the story, “When he told me about the affair I began sobbing and immediately I remembered when I was 18 and was raped by two men who then tried to drown me.” I was caught staring in amazement and what we had both just discovered. This traumatic event from 20 years earlier had been repressed and her husband’s infidelity had pulled off the scab and the wound was as raw as ever. We talked for some time about her past and present issues and I referred her that same day to a psychologist. When she returned to see me in two weeks her pain was significantly improved and she was working on dealing with the issues of life.

I almost operated on her and what I discovered that day was the mind holds so much power over pleasure and pain. As a physician I now try to dig a bit deeper into the patient’s medical history with pelvic pain. Studies have shown that women undergoing laparoscopy (a camera inserted into the belly-button) who are told everything looked perfectly normal inside, a majority will have resolution of their pain. Wouldn’t it be nice if we could get to this without having to look inside the body? In a ten minute appointment we can briefly exam the body, but it takes much more than that to really enter the mind-body connection.

Shawn Tassone, MD is a gynecologist in Tucson, AZ and is the author of Hands Off My Belly! The Pregnant Woman's Survival Guids to Myths, Mothers, and Moods. He and his wife are also the authors of the upcoming book "Spiritual Pregnancy" Nine Months of Transformation Before You Give Birth". Dr Tassone is the Director of Research in Complementary and Alternative Medicine for the World Institute of Scientific Exploration.

Shawn Tassone, M.D., is a board certified OB-GYN, Ph.D. candidate in mind-body medicine, and author of two books.

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