Endometriosis is an estrogen-dependent inflammatory disease that occurs when tissue similar to the lining of the uterus, the endometrium, is found outside of the uterus (1). It most commonly affects women during their child-bearing years, and often causes pain in the hypogastric and perineal regions, as well as the lower back (2). This pain can also include chronic pelvic pain, deep dyspareunia (painful sexual intercourse), dysmenorrhea (painful menstruation), dyschezia (difficult or painful defecation), and dysuria (painful urination). One research article even reported that a substantial number of women with endometriosis in their study had pain so bad “that it prevented them from going to work or they had to lay down frequently” (3). The pain caused by endometriosis can be severe, debilitating and complex, and there is no correlation between the severity of endometriosis and the experienced pain symptoms (2).
Common treatment options for endometriosis can consist of pain relievers, hormone therapy, or surgery. High-intensity exercise has also been suggested as a possible mechanism for pain relief as it not only increases endorphins, but it also decreases the amount of estrogen that the body produces. What about other treatments that can provide pain relief?
Mira et al. (2015) in a randomized control trial studied transcutaneous electrical nerve stimulation (TENS) as a potential complementary pain treatment for women with deep endometriosis (4). In this study, the electrodes were placed at the S3-S4 region. One group received acupuncture-like TENS (Frequency: 8 Hz, Pulse duration: ~250 µs, 30 minutes 1 x a week) while the other group received self-applied TENS (85 Hz, Pulse duration: ~75 µs, 20 minutes 2 x a day). Their results showed that all the women who received TENS, regardless of which type, had significant pain relief specifically with their symptoms of dyspareunia and dyschezia. In addition, ratings of quality of life for both groups also improved. In this study, TENS did not improve pain relief related to dysmenorrhea or dysuria.
Although the study had a small sample size of 22 women and no control group, one take away from this data is that for some women, TENS may be an effective, complimentary pain-relieving treatment to add to the care plan. Additional benefits of TENS units are that they are small, portable, non-invasive, low-cost and they can be used at home, overall making them relatively convenient and easy to use.
- Troyer, M. R. (2007). Differential Diagnosis of Endometriosis in a Young Adult Woman With Nonspecific Low Back Pain. Physical Therapy, 87(6),801-810. Accessed August 17, 2016. http://dx.doi.org/10.2522/ptj.20060141.
- Morotti, Vincent, & Becker. (2016). Mechanisms of pain in endometriosis. European Journal of Obstetrics and Gynecology, European Journal of Obstetrics and Gynecology.
- De Graaff, D’Hooghe, Dunselman, Dirksen, Hummelshoj, Simoens, . . . Wullschleger. (2013). The significant effect of endometriosis on physical, mental and social wellbeing: Results from an international cross-sectional survey. Human Reproduction, 28(10), 2677-2685
- Mira, T. A., Giraldo, P. C., Yela, D. A., & Benetti-Pinto, C. L. (2015). Effectiveness of complementary pain treatment for women with deep endometriosis through Transcutaneous Electrical Nerve Stimulation (TENS): randomized controlled trial. European Journal of Obstetrics & Gynecology and Reproductive Biology, 194, 1-6.
Written by Kayley Mikolajczyk, a 3 year PT student at the University of Minnesota and Assistant Director of Research for the Section on Women’s Health Student Special Interest Group.