Comparing period cramps with heart attacks isn’t useful or accurate

There is an article in Quartz about period pain (menstrual cramps or dysmenorrhea). While I agree many people, especially doctors, don’t take painful periods seriously enough I disagree with the assertion that we don’t know much about painful cramps. I’m also not a fan of comparing period pain to heart attacks. Heart attacks are not that […]

Vaginal Valium: another study shows it’s ineffective for pelvic pain

There are providers who recommend vaginal diazepam (Valium) for pelvic pain due to pelvic floor spasm. I have never understood why they do this as based on our understanding of how diazepam works it cannot be an effective therapy. I have written previously about vaginal diazepam (Valium) here, reviewing that diazepam works on GABA receptors which are […]

Livia isn’t a new off switch for period pain, it’s an expensive TENS unit

I’ve been asked so many times about Livia in the past month that I figured it’s time for me to just post on it. The makers of the device claim it is an “off switch for period pain” and that it is a “new device.” It’s neither. What Livia appears to be is a TENS […]

Stress and a bad diet can cause chronic pain, just ask my cat

As a pain medicine physician one of the hardest parts of my job is to get people to buy into the idea that addressing stress or anxiety or sleep or nutrition doesn’t mean I think their pain is “all in their head” or that I am not taking their pain seriously. Or both. Chronic pain […]

When cause of death is opioid overdose is it murder or malpractice? The case of Dr. Tseng

Is a doctor guilty of malpractice or murder or is the patient responsible for his or her actions when there is a death by overdose? This is the question that a jury in Los Angeles will have to decide as they are presented the facts in the case of Dr. Lisa Tseng. The prosecution’s version […]

10 natural therapies for killer menstrual cramps

Most women report some painful or discomfort with their period. However, some women have killer cramps (the medical term is severe dysmenorrhea) and for many of them life goes on a 3-5 day hold once a month. Period pain is due to release of a substance called prostaglandins from the lining of the uterus during […]

Hysterectomy for chronic pelvic pain? Ask these 7 questions first

Chronic pelvic pain (CPP, pain in the pelvis that is present for more than 2 weeks a month and has been there for more than 6 months) affects 15% of women and accounts for upwards of $2 billion a year in direct medical costs. To say it is a significant health burden is a gross […]

Vaginal Valium is ineffective for pelvic floor muscle spasm

A common cause (possibly the most common cause) of both pelvic pain and pain with sex is spasm of the pelvic floor (the levator ani and obturator internus muscles). Some physicians have promoted vaginal Valium as a treatment. There is a retrospective study of 26 patients (which has all the inherent problems of small retrospective […]

Low-dose naltrexone for fibromyalgia is not standard of care

This week I saw an interesting tweet about low-dose naltrexone for fibromyalgia purporting that this therapy is “standard of care.” I’m not that surprised since I’m asked about it now and then. Google “fibromyalgia and low-dose naltrexone” and the Internet is awash with efficacy claims. Even Medscape, a physician education portal, has a post from […]

Causes of painful sex (dyspareunia) simplified in one image

Up to 50% of women experience pain with sex (dyspareunia) at some point in their lives. There are a variety of causes, many of which are not considered by providers and/or patients. I’m lecturing on this subject today and came up with a slide that I think encompasses the main pain generators for dyspareunia, but […]