Persistent Pelvic Pain
Persistent Pelvic Pain
Pain is complex, and so is explaining it!
In this blog, we have broken down an overview of chronic pelvic pain into smaller chunks, to delve into the complexities of chronic pelvic pain and how to manage it.
What is chronic pain?
Pain is the body’s way of protecting us from harm. Short term or ‘acute’ pains - such as when you touch a hot stove (alerting you to move your hand) or after you sprain your ankle (telling you to rest and heal) should go away over time.
Chronic pain occurs when the pain is ongoing - even when the original cause of the pain has healed or tests and scans can show no abnormality. If pain is present on most days for more than 3 months you may have chronic pain.
Once the pain is ongoing for this length of time, it can cause changes to the nerve pathways which can make your pain more complicated to manage.
It is not known why chronic pain develops but we do know it is common to develop chronic pain when you have a condition like endometriosis.
Explaining pain
It’s common to hear from women who report that after they undergo a surgical removal of endometriosis they feel better for a while but then their pain returns. Then, upon repeat investigations or operations, endometriosis may no longer be found. So why is there still pain?
Persistent pain, in these cases, is less about pinpointing an injured tissue or structure in the body, and more about the sensitisation of nerves, the nervous system and changes to the musculoskeletal system that arise over time in response to repeated episodes of pain (often many years of heavy/painful periods).
When pain persists it becomes more complex as we need to retrain the brain and the nervous system to respond differently to triggers. Importantly, it is key to remember that pain is both a physical and emotional experience and can be impacted by many many things. Equally two people with the same condition will experience pain differently - no doubt if you’re living with pain, you already know this!.
Nerve Changes in response to persistent pain
The nerves in our body are constantly collecting information about the movements and sensations we experience and are reporting back to the brain where the information is processed and an appropriate action decided upon.
When the brain becomes used to receiving ongoing danger signals from a part of the body, it reacts to try and protect the body by enacting protective mechanisms.
These may include - turning up the sensitivity of the nerves in the area so they can pick anything that could be perceived as a threat, this then often happens incorrectly. The brain in turn can become sensitised - or on the lookout - for danger messages and therefore can start to detect threat at a lower threshold and in a wider area of the body. Typical ‘period’ pain may spread to the lower back or thighs over time and activities like intercourse or exercise might become painful when they weren’t before. The terms used to describe these changes are ‘peripheral and central sensitisation’ and are important to understand to get on top of persistent pain. Your physio may spend a lot of time explaining these concepts to you as it is just as important to help the nervous system unwind as it is to treat muscles and tissues. This does NOT mean that your pain is not real or ‘all in your head’. An ice cream headache is no less real or painful in the moment even though it causes no harm. In fact, we know the more you understand and re-frame your pain experiences the better the brain and nervous system learn that day to day activities are not dangerous but safe, ok and enjoyable!
Muscle changes
Sometimes the subconscious brain will start to become fearful of normal movements or activities and employ parts of the body to help protect itself from future threat. Commonly, in areas of persistent pain, we may find tense, tightened or spasmed muscles that are doing their best to ‘protect’ an area and limit the possibility of a painful movement or action occurring. As we talked about in part 3, a buzzy and sensitive nervous system can also signal muscles to switch on to protect and tight, tense muscles will compress nerves, increasing their sensitivity.
The problem with this is that, ongoing tightness in muscles can change movement patterns and cause the muscles to develop further pain. We often find tight, painful muscles within the pelvic floor, hips, glutes or abdominals in pelvic pain sufferers. Muscle pain might feel like sharp stabbing, or dull crampy aches.
Pain affects how we feel
Dealing with ongoing pain can be exhausting and frustrating and can create feelings of stress, problems with sleep or contribute to depression and anxiety. Importantly, these symptoms can also be the product of a wound up, sensitive nervous system so it can be a tough battle that can feel like you’re going in circles. Equally, a body running its alarm systems on high alert and muscles constantly set to go mode uses lots of energy and is, unsurprisingly, exhausting!
People will also commonly report that their pain takes a toll on their personal relationships or results in lots of absences from work. Persistent pain should be taken seriously as it has such a huge impact on quality of life. The sooner treatment can be sought, the better, but it isn’t too late to make improvements to function. Persistent pain is best managed by a collaborative approach between health professionals such as your GP, Physio, specialist, psychologist and other health professionals such as OT, myotherapists and more depending on your symptoms and how they impact your daily life.
Getting Help!
Each professional mentioned above has their own complementary approach to managing pain. As physios - we focus heavily on using our knowledge of pain to inform you about your condition which can be very empowering and help you to improve your control. Knowledge really is power and we know that understanding actually re-wires your brain and helps to reduce your pain. We can help provide strategies to settle, calm and desensitise your nervous system. We are also experts at managing muscle pain and can provide manual treatment, exercise based treatment and self-management strategies. We also have expertise in helping you formulate a return to activity plan and get back into the exercises and activities that you enjoy. In the end, we are here to empower you to take control!
If you need help managing your persistent pain, start by making an appointment with your GP and discuss how referrals to other health professionals can help you. We accept referrals under the EPC plan (which provides a medicare rebate on up to 5 physio visits each year). If you have questions about your persistent pelvic pain and how physiotherapy can help you, please get in touch.