Managing Long-Term Endometriosis Pain

Endometriosis is a complex and often misunderstood condition that affects millions of people worldwide. The Australian Institute of Health and Welfare tells us that one in seven Australian women are diagnosed with the condition by the age of 44. Even more concerning is the tidal wave of clients who report that it's nearly impossible to get GP's to take their concerns seriously. As if that wasn't enough, the pain that can accompany endometriosis can significantly impact physical, emotional, and psychological well-being. While there is no one-size-fits-all solution for managing endometriosis-related pain, psychological strategies can complement medical treatments and help individuals regain a sense of control over their lives.

This blog explores evidence-based approaches to managing long-term chronic pain associated with endometriosis, combining psychological insights with practical tools.

Understanding Chronic Pain in Endometriosis

The MayoClinic describes endometriosis as a condition in which pain stems from the growth of endometrial-like tissue outside the uterus, which can cause inflammation, scarring, bloating, nausea, heavy menstrual bleeding, bleeding between periods, fatigue, nerve irritation, anxiety, and depression. This pain is often cyclical but may become persistent over time, affecting areas such as the pelvis, lower back, abdomen, and rectum.

Psychologically, chronic pain is more than a physical sensation—it’s an experience influenced by emotional and cognitive factors too. This understanding forms the basis for many pain management strategies.

Psychological Strategies for Managing Chronic Pain

1. Cognitive Behavioral Therapy (CBT)

How It Helps: CBT is a widely researched approach for managing chronic pain. It helps individuals identify and challenge unhelpful thoughts about pain and replace them with more constructive ones.

• Example: Shifting from “I can’t do anything because of my pain” to “I can do things in a way that accommodates my pain.”

• Evidence: Studies show CBT can reduce the intensity of pain and improve quality of life by altering how the brain processes pain signals.

  
  

2. Mindfulness and Acceptance-Based Therapies

How It Helps: Mindfulness teaches individuals to observe their pain without judgment, while acceptance-based therapies like Acceptance and Commitment Therapy (ACT) encourage embracing discomfort as part of life without letting it dominate, much like having to wear glasses to accomodate poor vision.

• Techniques: Body scans, breathing exercises, and grounding activities.

• Evidence: Research indicates that mindfulness reduces pain-related distress and increases emotional resilience in people with chronic conditions.

  
  

3. Pain Education and Neuroplasticity Techniques

How It Helps: Chronic pain can lead to heightened sensitivity in the nervous system. Understanding how the brain and body interact when in pain can reduce fear and feelings of helplessness.

• Approach: Programs like Pain Reprocessing Therapy (PRT) train the brain to reinterpret pain signals as less threatening.

• Evidence: Studies in chronic pain populations demonstrate that reprocessing pain signals can lessen pain intensity in approximately 66% of participants.

  
  

4. Stress Management

How It Helps: Pain research has taught us that stress exacerbates pain by increasing muscle tension and activating the inflammatory system of our bodies. Managing stress through relaxation techniques can break this cycle.

• Techniques: Progressive muscle relaxation, breathing techniques, guided imagery, and yoga.

• Evidence: Regular practice has been shown to lower stress hormone levels and improve pain perception in endometriosis patients.

  
  

5. Building a Strong Support Network

How It Helps: Emotional support from friends, family, or support groups can buffer the psychological burden of chronic pain.

• Action Steps: Join endometriosis support groups, either in-person or online, to share experiences and creative coping strategies.

• Evidence: Studies highlight the role of social support in reducing feelings of isolation, lowering stress levels, and improving pain outcomes.

  
  

Lifestyle Interventions to Complement Psychological Strategies

1. Physical Activity

Gentle exercises like walking, swimming, or yoga can reduce pain sensitivity by releasing endorphins and improving circulation. Tailor activity levels to your comfort and gradually build up.

2. Sleep Hygiene

Chronic pain often disrupts sleep, and poor sleep intensifies pain. Establish a solid bedtime routine, limit screen time, and create a comfortable sleep environment (consider temperature, light/dark, non-restrictive clothing, comfortable bedding and covers. Sleeping in a cooler room with cosy blankets is most likely to result in a restful sleep).

3. Nutrition

While research is ongoing, some evidence suggests that anti-inflammatory diets rich in fruits, vegetables, omega-3 fatty acids, and whole grains may help manage pain. Avoid processed foods and excess sugar, which can worsen inflammation. If you are concerned about your diet, you can get in touch with a dietician privately or through a GP referral.