Why does PAIN occur? Understand the Mechanism of Pain

Pain is an unpleasant and distressing physical sensation caused by disease or injury, which induces hurt and anxiety in those suffering from it.
There are many different manifestations of pain, ranging from short term (acute pain) to long term (chronic pain). Other classifications include pain in the internal organs (visceral pain), injured tissue (inflammatory pain), nerves (neuropathic pain), etc.

The reason for the occurrence of pain depends on the cause and kind of pain being experienced. In most cases, pain acts as a warning sign that the body has been afflicted by a disorder of some sort, which may have arisen due to internal sickness or external wounding. Acute pains are generally cured on their own through rest or simple medication. Chronic pains, on the other hand, are more complicated in nature and the treatment requires more elaborate diagnosis.

The mechanism of pain

Pain is an extremely personal and subjective experience and affects each individual to varying degrees. The pain signals, which can arise in any part of the body, travel through the spinal cord to the brain along thousands of specialized nerves and nerve fibres. In the brain, it is processed in the centres associated with anxiety, emotions, memory, appetite, etc. Signals and pain inputs are then returned from the brain to the spinal cord, which may heighten or diminish pain.

In some cases, pain may also be induced by damage to the brain and spinal cord, which happens after a stroke.
A constant barrage of pain signals may cause the cells at the end of nerve fibres to become over-sensitized. This is known as 'wind-up' and is one of the most common causes of chronic pain that occurs even though the root of the problem has been identified and treated.

The causes and effects of pain differ from case to case depending on the signals received by the brain and its interpretation. It affects the individual's day to day activities and if persistent, can also have a harmful impact on mental health and psychosis. Pain is always handled, diagnosed and treated differently in all patients by drawing out the best possible solution to the problem.





Why does PAIN occur? Understand the Mechanism of Pain

Most women get accustomed to and know the pattern of their menstrual cramps. So, when something out of this pattern happens, they know it is not normal. There are various reasons for pelvic pains not associated with menses. The following are some common causes and it is always advisable to seek medical help, which will help in right diagnosis, early intervention and reduced complications.

1. Ectopic pregnancy: If a fertilized egg has planted itself outside of the uterus or the womb, it is referred to as ectopic pregnancy. The fallopian tube is the most common place for ectopic pregnancies. There is associated pelvic pain, which is unilateral, sharp, and gradually worsens. There would also be associated bleeding which is darker than the regular bleeding. This again should be confirmed on an ultrasound and then the ectopic pregnancy removed.

2. Endometriosis: The inner thick layer of the uterus could be infected leading to severe pelvic pain, especially in women who are in their 30s, who are not able to conceive. This is often ignored, considering it as normal and it continues to progress and could even result in infertility.

3. Pelvic inflammatory disease (PID): Infections like gonorrhea or chlamydia travel up from the genital tract and reach the uterus. Infection along the entire reproductive tract can lead to severe pain. In most cases, if identified early, a course of antibiotics is all that is required to control this infection. Left untreated, it can even cause infertility.

4. Ovarian cysts: Another common cause of pelvic pain, they are quite often asymptomatic, except for occasional pelvic pain. They also disappear with no medical intervention. Sometimes, however, it may get infected or rupture and can cause severe pain. This can is an indication for medical intervention. Ultrasound may be required for diagnosis and treatment may include surgical removal.

5. Uterine fibroids: The fibroids are noncancerous growths, which can grow to a considerable size and fall short of blood supply. This may cause them to burst, which can be very painful.

6. Miscarriage: Most miscarriages occur before 13 weeks of pregnancy and the usual accompanying symptoms of bleeding are severe pelvic cramps. If you are pregnant and notice bleeding with pelvic pain, it is advisable to immediately visit a doctor. Diagnosis may require an ultrasound to confirm the miscarriage. If medications are not sufficient to remove the remnants, then a dilation and curettage may be required.

7. Non-gynecological causes: Appendicitis, urinary tract infections, hernia, lower spinal problems, irritable bowel syndrome can also cause pelvic pain. The cause should be identified and managed accordingly.

Unfortunately, most women continue to experience and suffer with chronic pelvic pain without a cause identified. A thorough internal examination can help identify the problem and treat the issue.

How to Deal with Pelvic Pain other than Menstrual Cramps

Pelvic pain is generally referred to as the pain in the lower abdominal region. Pelvic pain might be acute, sudden, or chronic, recurrent, cyclical in nature. It may present as central or lateralized pain and might spread to the thighs and buttocks. Pelvic pain might be an indication that something is wrong with the internal reproductive organs located in the pelvic region such as ovaries, fallopian tube, uterus and vagina in which case occurrence of pain may be related to particular time in menstrual cycle.

Pelvic pain can be indicative of a pelvic infection or related to the pelvic bones/spine problems.

Also it may indicate that there is something wrong with the digestive system or urinary system.

Causes-

The causes are as follows:

Pelvic pain occurs commonly in disorders of the internal reproductive organs such as ovarian cysts or pelvic inflammatory disease (where in sexually transmitted bacteria spread through the reproductive organs and cause infection) or pain during ovulation.

Pelvic pain might also occur due to endometriosis (a form of disorder where the endometrial tissues that are located inside the uterus tend to grow outside the uterus resulting in severe pain), adenomyosis (a disorder wherein the endometrial tissues which line the wall of the uterus tend to grow within the uterus), , pelvic adhesions or ectopic pregnancy (when the fertilized egg gets inserted somewhere else other than the main uterine cavity),

Pelvic pain can occur due to bladder disorders, kidney stones, infection in the urinary tract, constipation, flatulence,inflammatory bowel disease, irritable bowel syndrome and chronic hernia.

It can also be a symptom in some cancers such as ovarian cancer, colonic cancer, advanced ovarian , endometrial and cervical cancer.

The following symptoms might occur along with pelvic pain:

Sustained pain in the hips and the groin

Sudden fever

Severe pain while urinating , passing stools or during sexual intercourse (dysparuenia)

Vaginal bleeding or vaginal discharge .

Blood in stool

Severe menstrual pain ( dysmenorrhoea)

Repeated instances of constipation or diarrhoea

Increase In pain with stress and physical movements

Investigations-

The Gynaecologist will do physical examination including bimanual internal examination. Also, complete blood count, urine for microscopy, vaginal swabs if discharge, stool examination. Ultrasound examination of the pelvis is an important investigation.

Treatment-

If the pain is gynaecological and depending on the cause doctors might suggest different therapies. In cases where pain is due to an ovarian cyst or endometriosis, doctors may prescribe birth-control pills. In cases of suspected pelvic infection, antibiotics are prescribed. Also, laparoscopic surgery might be advised in cases of acute pain due to cyst, endometriosis, or pelvic adhesions: for confirmation of diagnosis and excision or removal of cysts and endometriotic implants and division of adhesions respectively. In some cases of chronic pain, the gynaecologist may manage the case with inputs from gastroenterologist and pain consultant.

Causes and Symptoms of Pelvic Pain

During pregnancy a woman s body undergoes constant changes. The entire body tries to accommodate place for the growing uterus as hormones levels drastically fluctuate and ligaments stretched. Pelvic pain and the ensuing discomfort around this time is a common phenomenon experienced by most women. 

Though the pain may be harmless, at times it may also lead to serious repercussions. Therefore the identification of the causes that lead to pelvic pain during pregnancy is crucial. Some of them are: 

1. Accommodation pain: In the initial stages of pregnancy, women may experience cramps which are akin to the pain that precedes menstruation. However, in the case of pregnant women, the pain leads to no bleeding, but in all probability, is caused due to the expansion of the uterus.
2. Round ligament pain: Amidst the host of changes that the body goes through, the ligament that goes from the uterus to the groin also undergoes a change; it expands. This is responsible for the pain in the sides especially when women are walking or getting up from a chair.
3. Baby s weight: As the weight of the fetus begins to increase it exerts a pressure on the nerves that move from the vagina to the legs. This causes a dull pain in the pelvic region which increases considerably with walking and riding a car. This is most commonly felt by women who are in their third trimester.
4. Urinary Tract Infection: According to reports, most women suffer from urinary tract infection or UTI during pregnancy. This results in uncontrolled, often times, bloody urination and a pain in the abdomen. This is a major cause of concern as, if untreated, it infects the kidneys which in turn increases the risk of an early labour.
5. Miscarriage: In the first trimester, a pain in the abdomen may be an indication of a miscarriage. In such a situation, the pain is followed by bleeding and cramps.
6. Early labour: During pregnancy, an intermittent pain in the pelvic area and a back ache can also be suggestive of an early labour. If the contractions continue for over two hours after taking the necessary precautions like urinating and taking rest, it may be a sign of an early labor.

Pelvic Pain During Pregnancy

If there is a recurrent pain in the lower pelvic and the lower abdomen region of the body, chances are you might be suffering from pelvic pain. In women, severe pelvic pain can be a warning sign of some internal damage in the reproductive organs (ovaries, fallopian tube, uterus, and vagina) present in the pelvic region or the digestive system of the body. Although not common in men, pelvic pain might be indicative of an infection or severe pain in the colon region or the pelvic bones. Pelvic pain might be acute or chronic in nature and the pain might spread to the thighs and buttocks of the body.

The causes of pelvic pain differ among the genders, which are as follows:
1. For women, pelvic pain can be an indication of more serious disorders in the internal reproductive organs such as uterine cancer, cervical cancer, ovarian cysts, ovarian cancer and other pelvic inflammatory diseases (when the sexually transmitted bacteria spread to the reproductive organs and causes infections).
2. In women, pelvic pain might also occur due to endometriosis (a disorder wherein the internal endometrial tissues grow outside the uterus resulting in severe pain), adenomyosis (a disorder wherein the endometrial tissues which line the wall of the uterus start growing within the uterus), severe pain during ovulation and miscarriages.
3. The causes of pelvic pain in both men and women include sexually transmitted diseases, a disorder in the pelvic region or the bladder, kidney stones, urinary tract infection, colon cancer, and chronic hernia.

If you suffer from the following symptoms, chances are you might be suffering from pelvic pain:
1. Severe pain in the hips and the groin
2. Sudden fever along with the presence of blood in the stool.
3. Severe menstrual pain
4. You might feel severe pain while urinating or in the middle of a sexual intercourse
5. Bloody vaginal discharge might be indicative of pelvic pain in women
6. Recurring episodes of constipation or diarrhoea
7. Pain resulting from stress and intense physical movements

Treatment
If the pain is chronic, doctors might suggest prescribed a dosage of birth-control pills, antibiotic (especially for blood in the stool and pain due to infection) and anti-depressants. In extreme conditions, the doctor might prescribe laparoscopic surgery (operation by making minor incisions performed far from the actual source).

Can Severe Menstrual Pain be a Sign of Pelvic Pain?

Pelvic inflammatory disease (PID) refers to the infection that occurs in the female reproductive organs. It happens when sexually transmitted bacteria infect the uterus, ovaries or fallopian tubes on spreading from the vagina. Generally, the cervix plays the role of preventing the bacteria from entering the vagina and infecting the reproductive organs. But when the cervix becomes exposed to an STD, it loses its power to put a stop to the spread of these microorganisms to the reproductive organs.

What causes this condition?
STDs like gonorrhea and chlamydia have been found to be responsible for about 90% of PID cases.

Some of the other causes include
- Abortion
- Childbirth
- Pelvic procedures

The condition is only detected later in life when you face difficulty in getting pregnant or have chronic pelvic pain complaints. If you experience symptoms like vomiting, high fever, pain in the lower abdomen and instances of fainting, you should immediately seek a doctor.

What puts you at risk for PID?
Certain factors may put you at a higher risk for PID and these are:

- Instances of sexually transmitted diseases like Chlamydia (an STD that can occur from anal, oral or vaginal sex) and gonorrhea (a condition that causes discharge from the vagina or urethra) can make you prone to developing PID.

- Douching on a regular basis can increase your risk of PID as it disrupts the equilibrium of good and bad bacteria in your vagina, and may hide the symptoms of the condition as well.

- Even a previous history of PID can increase your chances of having another episode of PID.

- Compared to older women, teenagers who are sexually active are more prone to developing PID.

- Having multiple sexual partners can also put you at a greater risk for PID and STDs.

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