How to treat severe dysmenorrhea?

  A young Beijing woman with 5 years of dysmenorrhea and childbearing was encountered in the clinic. She had abdominal pain with heavy sweating and lower extremity stringing at each menstrual period. She had been examined in a gynecological clinic and had uterine fibroids and no other abnormalities. She took high doses of oral analgesics for each menstrual pain.  This woman was cheerful and I communicated to her that there was an injection treatment that could regulate the pelvic nerves and she was willing to have it. A lumbar sympathetic nerve block was performed in the operating room under ultrasound guidance one week before her menstruation. One month afterwards, she described to me that the menstrual pain had subsided, but she still needed oral analgesics, and that she had a lot of black blood during her last period, but she was not significantly nervous because she had been told before. After that, she had another lumbar sympathetic block, and the second time she was not nervous, and described to me that the local anesthesia was a little painful at the beginning, similar to a buttock, and then she did not feel anything. I gave her a total of three injections, one per month. After that, she described that it didn’t hurt when she got her period, but she could feel the tightness in her abdomen and thighs, and asked me if she wanted to have another shot to consolidate it. According to my experience, basically no one has relapsed after three injections, so I decided to continue to observe.  To summarize the cases of treating dysmenorrhea over the past few years, many women who came to my clinic for dysmenorrhea had already been excluded from the gynecology department for obvious organic lesions of the uterus and ovaries, and the pain was so intense that they were willing to be treated with injections. In these women, the dysmenorrhea is functional, which means that the local nerve dysfunction causes abdominal pain due to disordered contractions of the uterus that should contract sequentially from top to bottom. A nerve block can regulate these nerves and restore them to normal function. Many people feel little or mild relief after the first injection, but the relief is very obvious after the second injection, and basically relieves back to normal after the third injection.  Many people have safety concerns, the lumbar sympathetic nerve block is not an intraspinal closure, not to the inside of the vertebrae, but to the side of the vertebrae; at the same time, the ultrasound while lancing, more accurate and painless.