At some point, most women experience some degree of pelvic pain. If the pain is severe enough to disrupt your daily life, if it increases over time or if you have experienced a recent increase in pain, the experts at Newton-Wellesley Hospital can help you investigate the cause.

Determining a Cause
“The cause of pelvic pain can be complicated to diagnose,” says Antje Barreveld, MD, Anesthesiologist and Pain Management Specialist at Newton-Wellesley. “The pelvic area is made up of various components such as the bladder, gastrointestinal tract, gynecologic organs, nerves and muscles of the pelvic floor. It is not always immediately clear what may be contributing to the pain. Our team is committed to characterizing the cause of a woman’s pelvic pain and providing her with the support and treatments she needs.”

When a patient comes to the Pain Management Service with pelvic pain, the team completes a thorough health history and discusses the patient’s symptoms. The Service provides a variety of resources for patients in one convenient location. Patient care is provided by board certified anesthesiologists, interventional physiatrists (physical medicine), psychologists, nurse practitioners, registered nurses, radiologic technologists and physical therapists – all with special training in pain management.

“We encourage patients to keep track of their pain to help us determine the cause and see any patterns that may be associated with their pain,” says Dr. Barreveld. “This can also help us understand if the pain is cyclical and associated with gynecologic concerns. If the patient knows the pain occurs after eating, we have a better idea that it may be a gastrointestinal issue.” 

Some important questions include:

• When did the pain begin?
• Is it constant pain, or does it come and go?
• How long does the pain last?
• How severe is the pain?
• Is it a sharp stabbing pain or a dull ache?
• Is the pain always in the same place?
• When do you typically experience pelvic pain?


Pelvic pain that comes on suddenly over a short period of time is often a warning sign and should be evaluated promptly.

Common Causes
“Pain can be caused by an infection or inflammation,” adds Dr. Barreveld. “Pain caused by the bladder, bowel or appendix can produce pain in the pelvic region. Irritable bowel syndrome, kidney or bladder stones, nerve entrapment as well as muscle spasms or strains can also cause pelvic or lower abdominal pain.”

Chronic pelvic pain can be intermittent or constant. Some common causes of chronic gynecologic pelvic pain include menstrual cramps, cysts, endometriosis and ovulation pain. Treatments for pelvic pain depend on the patient’s specific diagnosis and can vary from medications to physical therapy. The Center for Minimally Invasive Gynecologic Surgery at Newton-Wellesley also sees patients to help determine the cause of and treat pelvic pain. This team approach at Newton-Wellesley gives experts a variety of treatment options and specialists to help patients treat their pain.

“We hope to provide patients with seamless continuity of care – from diagnosis to treatment. Our team is committed to helping patients determine the cause of pelvic pain and the appropriate therapies,” says Paul Satwicz, MD, Anesthesiologist and Director of Pain Management at Newton-Wellesley. “We provide a patient-focused, friendly environment to meet the individual needs of our patients. All of our patients receive care from board certified, attending level physicians and nurse practitioners who work to identify the cause of their pain and create a specific plan utilizing the latest methods.”

Dr. Barreveld is committed to working with patients to find solutions to their chronic pain. “Pelvic pain can be a mystery for many patients. I work to help them manage and find relief from their pain,” says Dr. Barreveld. “In addition to the physical aspects of dealing with pain, there are the emotional and psychological components that can be difficult to cope with. All of these areas must be taken into consideration.”

Treatment
Dr. Barreveld also works with health care providers throughout the Hospital to teach them about treating pelvic pain and the various options available for patients. These treatments can include medications that change the way nerves respond to pain, muscle relaxants and nerve blocks.

“Pain like menstrual cramps can often be relieved with medications that reduce inflammation, such as ibuprofen,” says Dr. Barreveld. “Sometimes the diagnosis will require the use of hormonal therapies including oral contraceptives and other types of hormones. Many women also experience depression from living with chronic pain and find antidepressants helpful.”

Physical Therapy
Newton-Wellesley has physical therapists who specialize in helping patients with pelvic pain.

“Seeing a physical therapist on a regular basis can greatly improve the pain many patients are living with on a daily basis,” says Dr. Barreveld. “I also suggest learning relaxation exercises and participating in cognitive-behavioral therapy to help change the way patients think about and cope with pain. These options provide emotional support and reduce stress.”

Determining the cause of pelvic pain can take time, but Newton-Wellesley has the resources patients need to treat and overcome this pain.

“We are able to come together and offer patients a variety of methods to treat their pain and improve their quality of life,” says Dr. Satwicz. “We want women to know they don’t have to live in pain – we are here to help.”

For more information about the Pain Management Service at Newton-Wellesley Hospital, please call CareFinder at 1-866-NWH-DOCS (694-3627) or visit www.nwh.org/pain.

Antje Barreveld, MD, Anesthesiologist and Pain Management Specialist, Newton-Wellesley Hospital 
Dr. Barreveld is board eligible in pain management and anesthesiology. She received her medical degree from the University of California, San Francisco. Dr. Barreveld completed her residency in anesthesiology and her fellowship in pain management at Brigham and Women’s Hospital.


Paul Satwicz, MD, Anesthesiologist and Director of Pain Management, Newton-Wellesley Hospital 
Dr. Satwicz is board certified in pain management and anesthesiology. He received his medical degree from the University of California, San Francisco and completed his residency at Beth Israel Hospital in Boston.

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