(AND AT THE BOTTOM OF THIS POST – PT2 OF MY INTERVIEW WITH SUE CROFT!)
This year, for the first time since 1979, the International Association for the Study of Pain issued a new definition of what pain is:
The definition is: “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage,” and is expanded upon by the addition of six key notes and the etymology of the word pain for further valuable context.
- Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors.
- Pain and nociception are different phenomena. Pain cannot be inferred solely from activity in sensory neurons.
- Through their life experiences, individuals learn the concept of pain.
- A person’s report of an experience as pain should be respected.
- Although pain usually serves an adaptive role, it may have adverse effects on function and social and psychological well-being.
- Verbal description is only one of several behaviors to express pain; inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain.
Essentially, pain is whatever you say it is – even if a doctor cannot find a cause or give you a diagnosis, this doesn’t make your pain any less real, or mean that the pain is just ‘in your head’. Pain is your brain trying to protect you…but sometimes the usefulness of the message is lost as tissues may heal, but the body and mind deal with ongoing stressors, as an inflammatory environment continues, and we need to develop a new way of living, flourishing and thriving.
The American College of Obstetricians and Gynecologists defines chronic pelvic pain (CPP) as noncyclical pain lasting 6 months or more affecting the pelvis, anterior abdominal wall, lower back, or buttocks that is serious enough to cause disability or lead to medical care, and it is estimated that between 20 and 25% of women are affected. Diagnoses which fall under the umbrella of ‘chronic pelvic pain’ include Endometriosis, Vulvodynia, Interstitial Cystitis/ Bladder Pain Syndrome and Irritable Bowel Syndrome.
Sleep, nutrition, stress management and movement are foundational aspects of living well with pain…but often, unacknowledged grief can be a barrier to moving forward with our lives. I recently heard Julia Samuel, author of ‘This Too Shall Pass: Stories of Change, Crisis and Hopeful Beginnings’ being interviewed, and two things she said stuck with me, particularly in the context of female pelvic pain = ‘Pain is an agent of change’ and ‘Grief starts at the moment of diagnosis’, which is certainly true for some diagnoses, like breast or gynae cancer.
But grief may not always start at the moment of diagnosis with chronic pelvic pain in women – many women are misdiagnosed or under diagnosed or mistreated or undertreated for years – many women believe that once they finally get a diagnosis, that this will unlock the door to effective treatment and restoration of their old life. However, this is not always the case – mismanagement may lead to fertility being compromised, an overdependence on a purely pharmaceutical approach may lead to long term physical and psychological dependence. A lack of acknowledgement of sexual health and wellbeing may lead to relationship breakdown. Chronic pelvic pain may lead to missed opportunities in education and the workplace too – 25% of women with Chronic Pelvic Pain spend 2 to 3 days in bed each month and experience decreased quality of life or feelings of sadness, depression, and anxiety. (Goncalves et al 2017). Changes in their lives have happened to them, but my goal is to help women bring in new changes – to help them live well after a diagnosis (or not…) of persistent pelvic pain. Is this their ‘new normal’? Is it a miserable one? What can we do to start taking back control and helping women live well? How can we put women with pelvic pain back in the driver’s seat of their health and wellbeing?
In the new ‘Female Pelvic Pain Rehab’ course, my goal is to give women’s health pro’s a toolbox – to recognise signs and symptoms, to help women advocate for effective treatment but also to provide an evidence based framework to help women live well – in a way that serves women and also serves the women in women’s healthcare. There will be strategies for manual therapy, exercise prescription, bladder and bowel health, moving from sexual pain to sexual health, optimising menstrual function and reproductive health, post-op recovery and scar mobility…eating well (what does the evidence say about nutrition and female pelvic pain?) moving well (what does the evidence say about the best exercise strategies for female pelvic pain) and living well – which means acknowledging the role of stress, sleep deprivation, catastrophising and anxiety…and what we can do about it.
For an insight into some of the strategies we’ll cover in the course (I say ‘we’ because there will be a closed Facebook support group where I’ll post ongoing resources and we can continue discussions), I’ll invite you to watch part 2 of the interview I did with the inimitable Sue Croft, who I’m delighted to remind you, will also be presenting at our Woman on Fire online extravaganza in 2021 (for a peek at our line-up and to book your ticket – have a look here!)
So stay tuned for more announcements on the Female Pelvic Pain Rehab course next week and enjoy part 2 of the interview (you can find part1 on my Youtube channel if you missed it – and if you’d like these blogposts delivered straight to your inbox – sign up for one of my free resources here!)
Until next time
Onwards & Upwards