Understanding Chronic Pain and Hormonal Overlap in Menopause

Chronic pain is a prevalent issue, affecting around 28 million people in the UK, which is 43% of the population according to the 2011 Census. Chronic pain, often persistent and difficult to manage, is a complex condition that can overlap with the perimenopause and menopause stages. Dr. Louise Newson recently hosted Dr. Deepak Ravindran, a leading expert in pain management and the author of The Pain-Free Mindset: 7 Steps to Taking Control and Overcoming Chronic Pain, on her podcast to delve into the science behind chronic pain and its relationship with hormones and inflammation.

The Prevalence and Mismanagement of Chronic Pain

Chronic pain is extremely common, yet it is often poorly managed. Dr. Ravindran notes that chronic pain constitutes the majority of GP consultations and has significantly evolved in our understanding over the years. Traditional approaches to pain management, which primarily rely on medications and interventions, often fall short of addressing the underlying causes of pain.

Dr. Ravindran's journey into pain management began over 25 years ago. Trained in India and the UK with a background in anesthesia, he realized early in his career that his skills in blocking nerves and administering medications were not sufficient for managing chronic pain effectively. This realization spurred his interest in the research potential of pain science, leading him to a fellowship in London and subsequently to his role as a consultant at the Royal Berkshire Hospital in Reading.

For the past 14 years, Dr. Ravindran has shifted his focus from anesthetics to pain management, integrating research and clinical practice. His interest in lifestyle medicine and trauma-informed care has led him to explore various non-conventional methods of managing pain, emphasizing the importance of understanding pain neuroscience.

The Importance of Listening and Context in Pain Management

One of the key insights Dr. Ravindran shares is the distinction between nociception and the pain experience. Nociception refers to the chemical signals released at the site of injury or inflammation, which are then converted into nerve signals. These signals travel through the nervous system, activating different parts of the brain involved in memory, emotion, and perception. The brain then interprets these signals and decides whether to trigger a protective response, which we experience as pain.

This interpretation of pain is influenced by various factors, including sleep, nutrition, physical activity, and social connectedness. Dr. Newson and Dr. Ravindran emphasize the importance of a holistic approach to pain management, considering these factors rather than solely relying on medications.

Inflammation, Hormones, and Pain

Dr. Newson highlights the role of inflammation and neuroinflammation in pain perception. She explains that the immune system and the nervous system work together to protect the body, and any imbalance can lead to increased pain sensitivity. The immune system, with significant presence in the gut and skin, constantly monitors and reacts to potential threats, influencing the nervous system's response to pain.

Hormones also play a critical role in pain modulation. Dr. Newson points out that optimal levels of hormones like estradiol and progesterone have anti-inflammatory effects, while low levels can lead to increased inflammation and pain perception. This is particularly relevant during the perimenopause and menopause stages, where hormonal fluctuations can exacerbate chronic pain conditions.

Bridging the Gap Between Pain Management and Hormonal Health

Dr. Ravindran acknowledges the need for greater awareness and education among healthcare professionals regarding the overlap between menopause and chronic pain. He suggests that pain clinics should consider evaluating hormonal levels and incorporating hormone replacement therapy (HRT) as part of a holistic pain management strategy. This approach could potentially reduce the reliance on medications like antidepressants and gabapentinoids, which often have significant side effects.

Dr. Newson shares her clinical experience, noting that optimizing hormonal levels can significantly improve symptoms of chronic pain conditions like fibromyalgia. She emphasizes the importance of parallel prescribing, where patients continue their current medications while introducing hormones, eventually reducing and possibly eliminating the need for other drugs.

Practical Tips for Managing Chronic Pain

To conclude, Dr. Ravindran offers three practical tips for individuals struggling with chronic pain:

1. Acknowledge the Reality of Chronic Pain: Understand that chronic pain is real and has a biological basis. Don’t let anyone diminish your experience.

2. Educate Yourself on Pain Science: Learn about the difference between nociception and pain, and explore various ways to manage your pain beyond medications.

3. Embrace Lifestyle Medicine: Focus on making your immune and nervous systems feel safe through proper nutrition, sleep, physical activity, and social connectedness. These changes can significantly impact your pain experience.

Dr. Newson adds that small steps in the right direction can lead to significant improvements in health and pain management.