First of all, if you are reading this blog because you’re experiencing pain, I’m so sorry. Pain can feel really frustrating, stressful, and isolating. I had chronic pelvic pain for over a decade, and I know what it’s like to bounce around the medical system between doctors, physical therapists, and alternative treatments trying to find answers.
Pelvic pain is an umbrella term. It can include diagnoses like vaginismus, vulvodynia, vestibulodynia, and interstitial cystitis. Sometimes pain isn’t even the right word–people feel like they are experiencing burning, itching, or irritation.
It’s always important to get checked out by a doctor. Doctors can assess for autoimmune disease, acute infection, or hormone imbalances that needs to be addressed medically. Some people have pelvic floor muscle tension and respond really well to pelvic physical therapy. If you’re looking for recommendations for specialists in the Triangle area, I’d recommend Dr. Yasmin at Alray Gynecology and Grace Pelvic Health!
But if you’re reading this blog, you may have already been to several doctors or pelvic PTs. So, what does talk therapy have to do with a medical condition? And why am I, a person whose last hard science class was Biology 101, talking about medical stuff?
Because! New research is coming out that once pain becomes chronic (about 3-6 months), our brains and nervous system get caught in a predictive feedback loop. This is called neuroplastic pain.
Pain is a danger signal from the brain. Think about it like a fire alarm. Sometimes the fire alarm is going off because there is a fire, but sometimes the fire alarm is going off because you burnt your tuna melt in the toaster oven. Essentially–our brains can send pain as a danger signal even in the absence of tissue damage.
This doesn’t mean the pain is all your head! The brain and nervous system are producing real pain, and it can be 10/10. It just means there isn’t necessarily something damaged in the body.
With chronic pain, we can get caught in the pain/fear cycle. Because we’re in pain, we are stressed or scared about experiencing pain. This puts our nervous system on high alert. In this hypervigilant state, our brains are more likely to interpret sensations as dangerous, so they send more pain as a danger signal.
So, that sounds bad. But the good news, if pain is neuroplastic, it can change. Pain Reprocessing Therapy is a newer therapy (developed in the last 10 years) targeted at treating chronic pain. It helps people retrain their brain and nervous system to get out of the pain/fear cycle.
How does that work? Overall, we are trying to get people’s nervous systems out of threat mode. This can be hard! Especially when someone has been in chronic pain, experienced trauma, or is experiencing a high amount of stress. Sometimes the education piece is enough. Knowing that pain doesn’t necessarily mean damage can be a huge relief, and the nervous system stops sending pain.
But often people need to experience a felt sense of safety in their body. A primary technique of PRT is somatic tracking. This is a guided meditation where people move towards the sensation of pain with curiosity. Often when we feel pain we brace against it, avoid it, or want it to go away. This is totally understandable! But it continues to send the message to our brain that the sensation is dangerous. During somatic tracking, we’re gently moving towards the pain with curiosity and messages of safety. This helps our brain reappraise the sensation, and it can start to learn that this part of the body is safe. Over time, the brain and nervous system stop sending pain signals.
I find that working with pelvic pain, as opposed to say, back pain, has its own complexity. Many people with pelvic pain experience pain during sex. This creates stress, pressure, or anxiety about sex. It can (understandably) decrease libido. If you’re experiencing painful sex, my advice is to stop “just pushing through” and white knuckling it. The goal is for sex to be a safe, positive experience.
Gentle, graded exposure to the pain can help the nervous system interpret the sensations as safe. This might mean taking penetrative sex (or whatever sex causes pain) completely off the table for a while. You can try exposures in a non-sexual context, like thinking about the pain and feeling the sensation of the emotions in your body. Often people will feel emotions of fear, anger, frustration, or sadness. Guided somatic tracking for emotions can be a helpful tool when those emotions emerge. Sometimes people feel pelvic pain throughout the day. If pain emerges, you can do somatic tracking with the sensation. But many people only feel pain during penetration. In that case, you can use your finger or a dilator to stimulate the pain and do somatic tracking exercises.
Another helpful avenue for nervous system regulation is emotional expression and feeling emotions in the body. Expressive journal writing is a common technique for reducing chronic pain. Traditional therapy recommendations like reducing screen time, setting boundaries, self compassion, and physical activity are also helpful.
It can be helpful to listen to recovery stories of other people who experienced pelvic pain and resolved their pain using these methods. This can help people feel less isolated and build hope. Here are some podcast episodes that have recovery stories. The podcast Heal Your Chronic Pelvic Pain is completely devoted to giving information on nervous system regulation for pelvic pain.
If you’re wondering how to assess if your pelvic pain is neuroplastic, check out the FIT criteria from Howard Schubiner. People can also experience mixed pain where it is partially structural and partially neuroplastic. In this case, PRT can still help reduce pain. Here is a podcast episode that goes into this theory for endometriosis. The nervous system is also involved in keeping muscles tight, so reducing fear and stress can help people relax tight pelvic floor muscles. Doing work with a trusted, caring pelvic PT can be helpful, as it creates a safe graded exposure to the pain.
If you’d like to find a therapist trained in PRT, here is a directory where you can search for providers in your area.