What do we know about Chronic Pelvic Pain?
Dr Louisa Gilles
August 2023
Chronic or persistent pelvic pain is real, is incredibly unpleasant and no one wants it.
It is frustrating, can stop you from doing what you need or love to do, and it is hard to see that it serves any useful function. Our knowledge about the drivers of chronic pain is expanding. Pain is not simply about tissue injury or disease (such as endometriosis) causing a problem. There are so many more factors involved including your nerves, muscles, brain, immune system and endocrine (hormonal)system. These in turn are affected by stress levels, sleep, the psychological and social aspects of your life. If you have had a trauma experience, this can also impact.
A simple analogy is when you stub your toe. If this happens on a day where everything is wonderful, and you are rushing off to some very happy event, you will feel the pain, but may easily take it in your stride and continue what you are doing. When it happens on a day where you haven’t slept, a million things have gone wrong already and you are a professional dancer and are worried if this will affect your career, the same injury is likely to hurt a lot more.
Pain depends on context. The pain experience is a convergence of biology, psychology and society.
When pain persists for more than a few months, your sensitivity to pain changes and tissues tend to become hypersensitive. The pain you experience becomes less related to tissue drivers, and more driven by other processes that your body has set up to try and protect you. Your brain has perceived a threat, whether there is a real or ongoing threat or not.
Terrible pain doesn’t equal terrible pathology. Sometimes the cause of persistent pelvic pain can be unknown, but there is still a lot that can be done to help ease it. It is useful to examine what fears and ideas you may hold about your pain, sometimes without realising.
Now for the good news: many different things can help with chronic pain.
Firstly, having an understanding about the science behind chronic pain, which may be different to the ideas and beliefs that we all carry, can actually help to improve your pain experience. Working in many ways to “turn down the volume” from the signals that are driving the pain is where we can target treatment.
Movement (especially under careful instruction) is likely to help, as does having a supportive team (of healthcare professionals and in your personal life.) Self talk is also a very important coping strategy, and managing your pain most likely will involve a change in the way you relate to the pain experience.
Your pain experience is unique to you, and the journey to manage it will not be the same as anyone else’s. Arming yourself with knowledge, as many tools in your toolkit as possible, and finding the right team is a good place to start.
For more information about chronic pain check out:
https://www.pelvicpain.org.au/learn/for-women/
