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15 Articles in Volume 18, Issue #5
Chronic Pelvic Pain: The Need for Earlier Diagnosis and Diverse Treatment
Cross-Linked Hyaluronic Acid for the Management of Neuropathic Pelvic Pain
Fentanyl: Separating Fact from Fiction
Gender Bias and the Ongoing Need to Acknowledge Women’s Pain
Letters to the Editor: 90 MME/day Ceiling; Ehlers-Danlos; Redefining Pain
Post-Menopausal MSK Pain and Quality of Life
PPM Welcomes Dr. Fudin and Dr. Gudin as New Co-Editors
Practitioner as Patient: Understanding Disparities in CRPS
States Take Action to Manage Opioid Addiction
Step-by-Step Injection Technique to Target Endometriosis-Related Neuropathic Pelvic Pain
The Many Gender Gaps in Pain Medicine
The Need for Better Responses to Vulvar Pain
Topical Analgesics for Chronic Pain Conditions
Topical Medications for Common Orofacial Pain Conditions
What’s the safest, effective way to taper a patient off of opioid therapy?

Cross-Linked Hyaluronic Acid for the Management of Neuropathic Pelvic Pain

Case presentation and injection technique targets endometriosis-related pain.
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Overall, this case provides a detailed look at the use and technique of targeted neural matrix antinociception injection of cross-linked hyaluronic acid in the successful treatment of chronic endometriosis pain of the thoraco-lumbar, sacral, and right greater trochanteric region that occurred in a 41-year woman who had previously undergone multiple endometriosis pain related surgeries with no change. The technique presented has resulted in the patient’s enduring pain relief, and proved to be a safe and effective method in this patient (see the Patient's self-reported commentary below). Its routine use should be considered early to manage pain in similar cases.


Patient Commentary

“I was officially diagnosed with severe endometriosis when I was 26 years old. Although, I am very certain it started years before when I was in my teens. My periods where always very heavy flow and extremely painful—painful enough that I would always need a day or two off from school or work. I started taking birth control pills when I was 18 and that seemed to suppress the progression of the disease or at least the symptoms. After I had my first child, when my cycle resumed, the pain returned. My doctor did ultrasounds, MRIs, and x-rays trying to find the cause. She decided to do an exploratory laparoscopy and that’s when they discovered I had severe endometriosis.

Over the next 15 years, I had five more abdominal surgeries. My right ovary was removed, my uterus, my appendix, along with both of my tubes and my cervix because they were covered with the disease. The endometriosis continued to spread and do damage to many nerves in my pelvic area. The nerve damage caused severe pain in my right hip, low back, and my pelvic area.

The pain gradually got worse, increasing from a few days a month to everyday. I was put on countless medications. From pain meds to hormones, birth control pills, IUD and the worst was a medication that shut down my ovaries and put me into medical menopause. I used OTC pain relievers until my stomach couldn’t handle them anymore, as well as ice, heat, and local lidocaine to no avail. Another pain management doctor gave me more medications to try as well as nerve ablation—none of which helped.

The pain was so intense that, most days, I was forced to stay home. I was unable to take care of my home or my children. I was also unable to have sex because it was too painful. When more surgery was no longer an option I began seeking someone to help me deal with the pain. At this point in my life my life quality was terrible. A friend recommended Dr. Campa [the author]. I saw him and he started a treatment plan with the injections. He gave me injections in my right hip, low back and my pelvic area.

Very early in the treatments, I began to feel improvement. The injections would bring my pain scores from a 9 or 10 down to a 2 or 3. The only drawback was that it was short relief. While they were working I was able to start participating in my family life again. I would get the injections once a week. The first three and four days were great but over the next day or two the pain would return. Although while they were working, I could be active and have intercourse that wasn’t painful. The only drawback was that the relief was so temporary.

When Dr. Campa started giving me the cross-linked injections the onset of pain relief was within 24 hours or so. The great thing about them was that they lasted for months not days! Comparing the two different injections, the cross-linked injections brought my pain scores of 9 or 10 to a 1 or 2. Only getting injections every 6 months or so compared to weekly has been so much easier and the time I saved I am able to devote to my family. The long-term pain relief has been an absolute blessing.

Before the cross-link injections, oxycodone and hydromorphone would help minimally with all the nerve pain and abdominal pain from the scar tissue and adhesions. The oral pain medication barely took the edge off of all the pain and I spent most of my time in bed or on the couch unable to move. The cross-link injections brought down my pain levels in my right hip, low back and pelvic area nerves enough that the oral pain medication made the scar tissue and adhesion pain more manageable. I continue to take oxycodone and hydromorphone to help with the severe pain that isn’t nerve related. The scar tissue and adhesion pain is a pulling pain across my whole pelvic region, but the most intense pain originates from the lower right pelvic region. This pain is controlled with opioids, which lowers the pain score from a 9 or 10/ out of 10 to about a 6 out of 10.

In the areas treated with the cross-linked injections, the pain is a least 90% better. The other areas seemed to improve some but it’s hard for me to tell if they actually improved or if they are easier to manage since the other pain is so much better.”

–Commentary provided by the author with patient permission.


Also featured in this special report on Pain Care & Research in Women

Continue Reading:
Step-by-Step Injection Technique to Target Endometriosis-Related Neuropathic Pelvic Pain
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