The move back to mental health issues and central sensitization issues is dangerous. It gives inadequately trained surgeons tools to abuse patients who still have active disease. Most of the time, the patients we refer on have been dismissed as neurotic, and or told it is cs and they still have improperly treated endometriosis. I know there are pelvic pain conditions that are caused by things other than endometriosis. But when we fail to adequately treat patients and then label them and put them into mental health treatment while ignoring the active disease, we are stepping backward 100 years into the hysterical woman era or even further into the times of ancient Greece.
When the esteemed Prof Shirley Pearce of the UK showed us that abnormal mental states clear with adequate treatment, I find using these “new approaches” of including mental health dx before adequately treating the patient to be misogynist, disrespectful to women, transgender and others. It becomes a tool to abuse patients even further, offering excuses to use drug therapy where skilled surgery is missing.
Now, a large study in China has noted that central sensitization begins to clear in a few short months after pain is relieved with proper surgery. That crutch will soon go away, no, wait, misinformation takes on a life of its own and misleads the industry for decades. The drug companies take advantage of those surgeons who do not have advanced skills by marketing the drug for moderate to severe symptom relief. However, in their own literature, Dr. David Redwine noted that it was not as effective as claimed, but continues to be marketed as an effective tool. If physicians are not reading the fine print and actually asking patients how they are doing, this gets missed. This disease impacts interactions with family, with partners/spouses, with employers, with education efforts, and physicians should be inquiring about how patients are doing in these areas. These poor interactions are not mental health issues, they are PERITONEAL QUALITY PAIN issues, and deserve to be heard and addressed. If the physician does not treat other pelvic pain generators then referring on to pain managers is a compassionate thing to do, or to pelvic PT, or even consider that all endometriosis may not haveall been removed, or has recurred and needs to be addressed. Too often physicians insist on a course of medical suppression and never follow up how the patient is doing. When a group of physicians in Thunder Bay. Ont. thought they were curing endometriosis with triple dose Danazol, I asked the crowd why the doctors believed that? The answer was, “we don’t go back, because they do not believe us.”
Other times physicians will leave disease on the bladder or bowel as insignificant and “treat” it with medical menopause meds. Wrong on many levels as there is no medication that treats endometriosis and low estrogen states occurring thru suppression with drugs has lifelong impact, not immediately acknowledged. Small vessel heart disease, permanent bone loss, and cognitive issues have all been associated with low estrogen states cause by medical menopause (drug induced) or surgical castration. The reasons for such an approach need to be questioned as the drug companies now maintain a speakers bureau of physicians and these physicians are treating patients.
Indeed, these concerns get pushed on down the patient’s life span and once they have occurred, you can’t go back. Those choosing to not excise disease, take the easy way out with suppressive drugs, creating a future of significant health issues for which they accept no current responsibility. Drugs have a role in gynecology, but they do not treat endometriosis and suggesting that they do, is misleading patients.
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