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Endometriosis is a painful condition in which tissues similar to the lining of the uterus grow in other parts of the body.
For many with this condition, this can lead to severe abdominal and pelvic pain, bloating, infertility and fatigue (among many other symptoms). Endometriosis pain is often debilitating and can significantly limit a person's quality of life.
One of the primary symptoms of endometriosis is chronic pain. Chronic pain is pain that lasts every day for more than 3 months.
Because chronic pain consists of daily pain for such an extensive amount of time, it can ultimately lead to central sensitisation.
What is Central Sensitisation?
Central sensitisation is a process in which the central nervous system becomes hypersensitive to pain signals, leading to increased pain perception and decreased pain tolerance.
It's very important to note that pain is ALWAYS real, and the brain ultimately decides when to react with pain. The body sends danger signals, but the brain ultimately makes the call on how much pain to respond with.
In cases of endometriosis, central sensitisation occurs from repeated exposure to chronic pain, leading to abnormal pain processing in the brain and spinal cord.
The brain is smart. It wants to protect you from the danger messages of this debilitating condition, so it becomes hyper-alert to the threats it's constantly experiencing.
And in its effort to stay on alert, its warning system has become more powerful too: turning up the volume on the already incredibly severe and debilitating pain.
It has effectively rewired itself to remain alert to pain, thinking it's helping you — warning you of a threat to your body, even if there isn't one (e.g., months after a successful surgery).
An easy way to understand this is to think of your body like a car with an overactive alarm system.
Most cars require someone breaking into them for the alarm to sound. For your car, it feels like it's constantly being broken into. As a result, even just a small leaf falling on the hood (or slight bloating) will send the alarm signals screaming.
And because the central nervous system becomes hypersensitive to pain, this can substantially prolong the pain experience, even after the actual source of pain has resolved (e.g., after surgery, where the endometriosis tissue has been excised).
This can be incredibly frustrating following your surgery. It's very natural to have high expectations for your recovery (as you should). And it's very normal for the body to experience the natural pain that comes from surgery and the healing process.
But when you continue to experience higher pain levels several months following a successful surgery, it can begin to feel hopeless.
How Mindfulness Meditations Help Manage Central Sensitisation
While the ongoing pain following your surgery can be a heartbreaking reality, there's actually some really good news.
Mindfulness meditations have long been studied and recognised as an effective strategy for managing chronic pain, and they are a promising technique for managing chronic pain associated with endometriosis. They do this by targeting central sensitisation and changing the way the brain interprets the 'threat'.
To oversimplify it, meditations for pain relief re-train the way the brain processes pain, causing it to turn the volume all the way down.
This is due in large part to their focus on present-moment awareness, an attitude of non-judgemental acceptance, and a compassionate attitude towards oneself and others. This technique has been shown to reduce pain perception, improve mood, and reduce the severity of chronic pain.
Several studies have investigated the effectiveness of mindfulness meditation on central sensitisation pain caused by endometriosis. One study found that cis-women (who had not found pain relief from conventional medical treatments) decreased all endometriosis-related pain following a trial of mindfulness-based interventions.
Another study showed that cis-women who participated in an eight-week mindfulness-based stress reduction program reported significant reductions in pain severity.
An important aspect of mindfulness meditation involves paying attention to the present moment without any judgement. This is particularly helpful for managing how you think about and react to your pain.
Regular practice of mindfulness meditation can help reduce stress, anxiety, and improve mood — leading to a reduction in pain perception. You can start practicing by listening to some fun, science-based meditations here.
Other Methods to Manage Central Sensitisation
There are a variety of other methods that you can incorporate to help holistically manage your central sensitisation, to ensure it's effectively treated. These other methods include:
Learning about how your pain works - Understanding your pain triggers and how the brain uses pain to protect you is an incredibly empowering way to manage your pain. Understanding your power in managing the pain brain can significantly reduce your stress response and pain fears, which breaks the pain cycles. Resources like the Explain Pain Handbook are widely used by pain specialists to help patients take control of their pain brain and lives. A good place to begin is understanding your DIMs and SIMs triggers.
Pacing - We naturally avoid activities and the things we love because of our pain. Pacing is a science-backed method to help avoid boom-bust cycles from endometriosis. Pacing is a method of pre-planning your days to help you gradually increase your activity levels. This is particularly important for getting reacquainted with activity and exercise following surgery. It helps the brain adapt to activity exposure in a graded and well-managed way. This creates safety in the body and reduces the pain response over time. More information on pacing and goal setting can be found here.
Pelvic floor physiotherapy - One of the most important things you should do following your surgery is see a pelvic floor physiotherapist. The stress from your pain naturally gets caught in the pelvic floor, causing you to contract these muscles — usually with little awareness. This results in muscle tension and charley horse spasms in the pelvis (which can sometimes be worse than the endometriosis pain). Pelvic floor physiotherapy teaches pelvic floor relaxation techniques, and if you're comfortable, your physiotherapist can perform an internal exam to help identify any pelvic floor dysfunction and help you release your pelvic floor muscles. Pelvic floor physiotherapy is also massively helpful if you're experiencing any bladder dysfunction due to endometriosis.
Understanding your food triggers - I think for many endo warriors, this can be the hardest one to manage since it can be difficult to specifically zero in on your triggers. However, endometriosis is usually accompanied by IBS-like symptoms and poor gut health, which can be a major cause of your pain. As such, diet is also one of the most important ways to help manage your mood and symptoms. Understanding your food triggers — and which foods lead to severe pain — can help minimise and eliminate future flare-ups. This helps the brain limit its pain response. Working with a registered dietician on the short-term low FODMAP diet is a massive step in taking control of your pain by identifying your specific food triggers.
The main takeaway is that there is hope. It may take some time, but it will definitely get better. Feel empowered on your journey in taking control of your pain.
Your body will only become stronger and more resilient — and you'll learn so much about yourself in the process that you probably won't recognise this new, stronger, pain-free version of you.
You've got this.
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