08/18/2015
RELATIONSHIP BETWEEN DIFFERENT ORGANS - CROSSTALK OF CHRONIC PELVIC PAIN - (EDITED and EXPANDED VERSION from 8/13/15 original poist) There has been some very interesting research showing how damage to one of the pelvic organs can induce damage in other organs. Much of the work was pioneered by Dr. Pezzone in Pittsburgh. The mechanism seems to be: 1) damage or irritation to say the bladder is detected by the endings of special kinds of nerves (nociceptors) through a process call nociception (commonly called “pain receptors”, but technically incorrect – see below). The impulses that these nerves send to brain via the spinal cord signal (ie inform) the brain that some damage has occurred to the bladder. In chronic pain, some of these nerves start to send signals all by themselves – ie they are on “autopilot” (this phenomenon may account partly for “phantom pain”) 2) Those nerves "set off" nearby nerves (like having one crying baby in the room “set off” the other babies and make them cry also) from say the bowel and the brain interprets this as though the signals actually came from the bowel, (called "CrossTalk"). 3) These impulses set off nerve impulses which travel BACKWARDS to the bowel where chemicals are released by the nerves which cause an actual physical inflammation (the basic process that occurs after any tissue injury). This in turn can trigger its own actual set of signals being sent to the brain by the process described above.
This process can lead to not only pain but also functional impairments of the organs. It can happen with a number of the organs in the pelvis which is why we often see a number of conditions in the same pelvic pain patient – IBS, IC, pelvic pain, sacrolilac joint pain/dysfunction, pelvic floor dysfunction, vaginal pain/ vulvodynia, prostatitis etc. Often there is a sequence as to when symptoms will arise.
In addition, the muscles of the pelvic floor will tense and spasm in reaction to the pain. This will reduce pinch blood vessels and reduce the oxygen in the tissues. When this happens you get a sort of “Charlie Horse” and chemicals are released by the oxygen-deficient tissue which cause more spasm. Nerves are stimulated by these chemicals and also by being pinched to send more messages to the brain about damaged tissues, which can result in more pain. So more pain, more spasm, more spasm more pain.
This will also cause tension in the sacroiliac joint, pulling the joint in unusual ways and give rise to pain there also.
http://www.ncbi.nlm.nih.gov/pubmed/20025032
[For those who enjoy a bit more technical detail:
Now we all know that just having these signals go to the brain doesn’t guarantee pain. Pain is the emotional response which takes into account all the signals that come from around the body and puts it in the context of personality, history, emotional state and so on. We have all heard of athletes continuing to play even after sustaining what would normally be a painful injury. Certainly the injury has initiated the process called nociception, but until the brain processes ALL of its information and “decides” what to do about it, there is no emotion we call pain.
So anywhere you have the ability to stimulate these specialized nerve endings, or to cause damage to nerves themselves eg an endometriosis lesion, a scar from surgery, a damaged bladder or an adhesion that is pulling on a scar/nerve etc.) you have the ability to set off this process called nociception – which in many cases results in pain.
I have used the term “pain” chemicals even though this is not strictly accurate. The chemicals don’t cause pain. They are one way to induce the process called nociception, which may result in pain]
(editied - Thanks Antony PhysioDetective Lo for your comments)
Neurourol Urodyn. 2010;29(1):77-81. doi: 10.1002/nau.20817. Research Support, N.I.H., Extramural; Review
