Fatigue and Endo

Hi there yet again,
It's a beautiful day here in Bend Overagain (that's what my friend Brad calls Bend), plus, I just figured out how to stream jazz over the internet into my little speakers on my desk. Cool.
Well, in my quest for new and interesting things to write about, I was asked to enlighten you all about endo and fatigue. Now this is a difficult topic, because there is not much in the literature about these 2 entities. One paper was written by some people at NIH and Mary Lou Ballweg, the founder of the Endo Assn. They sent out a survey to over 3000 women with endo, and asked about their pain, and any other diagnoses they'd been given. As you can imagine, these types of papers are not the most reliable, because they're based completely on the responses of individuals, which are truthful most of the time, but sometimes there can be some bias interjected. Regardless, this paper does give us some idea of the prevalence of various other diseases in women with endo compared to the general population. "Chronic fatigue syndrome" was much more common in women with endo than in the general population, but was still a very small percentage (4.6% vs 0.03%). Chronic fatigue syndrome is a nebulous diagnosis in the way that fibromyalgia is, where there are symptoms present but no known cause for them, and the authors did not comment on why the incidence was so much higher in women with endo. Just looking at fatigue in general, chronic pain can induce fatigue, depression, and anxiety. This may happen because of how pain limits activity, and with decreased physical cardiovascular activity, there usually follows a sense of tiredness.
It may be due to chemical mediators of inflammation that are produced by the endo and get absorbed systemically and act on the brain to cause fatigue. Or, it may be due to changes in the part of the brain where pain and emotions are processed. Chronic pain has been shown to cause atrophy in certain areas of the brain (thalamus and dorso-lateral prefrontal cortex). This increases the emotional component of pain, and decreases one's emotional reasoning powers. There is much that is yet unknown about the way the brain processes pain, but suffice it to say that it is very complicated, with interactions between chemical mediators, receptors for natural chemicals like seratonin and dopamine, opioids, and various other modulators of nerve cell function. I'm fascinated by why some women (not too many, thankfully) continue to have pain after their endo is excised. We all know that endo is only one of many sources of pelvic pain, but it is the only one with a defined cure. There is research into why there is such an overlap between patients with Interstitial Cystitis (IC), Irritable Bowel syndrome (IBS), and Vulvodynia (inflammation of the vaginal opening). The current thoughts are that there is cross-innervation of all the pelvic organs, and when one is inflamed, it causes inflammation in the other organs via nerve mediation (neurogenic inflammation). Why are some women lucky enough to have their pain resolve after their endo is excised, but a few have the persistent "chronic pelvic pain" syndrome with this cross-innervation and cross-inflammation? Probably it goes back to what makes us individual - our genes.
I don't want to make you discouraged by this - by far the majority of women with endometriosis have a dramatic reduction of pain after excisional surgery, but there are a few (ironically with typically very little endo) that don't, and those are the puzzling ones I was referring to above.
I am confident that the research into nerve and brain function specific to pain processing will continue, and continue with the focus on pelvic pain, so that a few years from now we'll look back and laugh at how uninformed we were back in 2007, like looking back at the days before penicillin. I want to encourage all of you to persist in finding solutions to your pain. Everyone has a slightly different journey, but my hope is that you can find a way to live happy, productive, pain-free (or at least pain-controlled) lives. I heard someone say that the key to being happy at work is to feel like you have a purpose, and that you're pursuing that. I know that my purpose in life is to help women with pain, (and incontinence), and in so doing to swim upstream against the current of Lupron, Lasers, and ineffective management of endo.
I wish you all well, and again, I will be happy to review any of your records to see what we can do for you here in Bend. Let me know what topics you're interested in reading about.
Have a great week.
Dr. Mos