Pelvic Pain and your Brain
by Angie Bon
Chronic pelvic pain can be debilitating and typically impacts people in various areas of their lives, from finances, relationships, and work, to name a few. Managing pelvic pain can be costly as you may be seeing a team of health professionals and using several medications. At work, pain may interfere with your concentration and your energy levels, or lead you to take numerous sick days. You may experience painful sex and intimacy issues due to the fear of pain. You may become snappier or appear flaky to friends as you have to cancel plans because of this crippling pain. Health professionals might have told you that you're imagining symptoms and that the pain is all ‘in your head’. Your pain IS real. However, recognising the role your mental wellbeing plays in pain is something not to be ignored.
What is chronic pelvic pain?
Chronic pelvic pain is pain in the area below your belly button and between your hips that lasts for 6 months or more, according to Pelvic Pain Foundation of Australia. Pelvic pain can be associated with other conditions, including endometriosis and adenomyosis, although pelvic pain can exist on its own. Approximately 15% of cisgender women worldwide, and 25% of cisgender women in Australia, experience chronic pelvic pain according to an article by the Journal of Pain Research. Pelvic pain is not uncommon in the transgender and intersex community, although there is limited data.
Our minds and our bodies are connected
Our minds and our bodies are not separate, and our thoughts, feelings, beliefs, and attitudes can positively or negatively affect our physical wellbeing. For example, when you’re stressed, you may experience tummy issues. When it comes to pelvic pain, there is a clear link between the physical pain experienced and our brain. So while the causes of pelvic pain are multifactorial and diverse, it can lead to emotional distress and depression (Journal of Pain Research, 2020). Meanwhile, emotional distress and mental health conditions can also impact how you experience pain.
According to the Journal of Pain Research, people with pelvic pain experience higher rates of mental health concerns. Around 60-80% of people with persistent pelvic pain experience depression and over 65% have reported to experience anxiety (Journal of Pain Research, 2019). If you’ve experienced pelvic pain, or have listened to the stories of those going through this, these stats won’t surprise you. There is an emotional pain that often accompanies the physical pain experienced.
Perhaps receiving a diagnosis has been a long exhausting process for you, and you've seen several health professionals who have dismissed your symptoms. Once you’ve received that diagnosis, learning to cope with pain can be exhausting, upsetting and stressful in itself. Not only can physical pain affect your emotional states, your moods, your thoughts and emotions also affecty our pain. According to the Pelvic Pain Foundation of Australia, if you’re tense and anxious, because of work or relationships, for example, this can heighten pain. Why is this? This is because the pelvic floor muscles actively contract in response to physical or mental stress, which is a result of the pelvic stress reflex response (Investigative Urology Journal). When you’re hypervigilant and catastrophize - that is, being consumed by pain symptoms and hopelessness - it leaves you experiencing pain more easily. This is because pain is felt when the brain perceives a threat of a situation is greater than the perceived safety. So, when you are hypervigilant, your pain tolerance becomes lower Journal of Physical Therapy). Additionally, catastrophizing can actually amplify pain. A study by The Journal of Clinical Obstetrics & Gynecology found that catastrophizing is strongly associated with pain severity and poorer quality of life.
So what does this all mean for managing pelvic pain?
The International Association for the Study of Pain and the Australian Pain Society recommends addressing both the physical and psychological symptoms through a team of specialists, which may include a psychologist or counsellor, for best outcome (Brooks et al. 2020). Psychologists So, looking after your mental health is an important part of managing your pelvic pain. Let’s look at some ways a mental health professional can help you in this space.
Cognitive Behavioural Therapy (CBT): More and more research is indicating that CBT is an effective psychological intervention for managing pelvic pain (see Journal of Pain Research 2020 and the Journal of Contemporary Clinical Trials Communications 2020). CBT works by challenging unhelpful behaviours and ways of thinking. This is because you may find yourself stuck in a cycle where your fear and thoughts and emotions about pain, can actually increase your distress, your physical pain and lead to avoidance of things you used to do (Journal of Physical Therapy 2011). An example is being consumed by worry that your pelvic pain will become too much when you’re out hanging with friends, which could lead you to avoid such social outings altogether. Therapy can help in challenging those pain-related thoughts and emotions.
Coping strategies
You don’t need to have a mental health disorder to seek support for your mental wellbeing. As humans, we are all affected by emotional distress at some stage in our lives. With pelvic pain, it’s more than just pain. It’s about the stigma, feeling that your pain is not taken seriously, feeling helpless, and the effects on your relationships, finances and your career. You may choose to speak with a mental health professional after dealing with the process of getting your diagnosis and adjusting to living with pain. You may want to discuss life events that are affecting you, as your ability to cope will increase when you’re feeling your best. For example, if you’re feeling low, it can be hard to find motivation and energy to use your tools for pain management and to attend medical appointments. Learning positive coping mechanisms, and relaxation techniques, may benefit your mental health and your ability to cope with your pain if you’re finding yourself dealing with anxiety, stress or changes in mood (Journal of Multidisciplinary Healthcare 2021).Additionally, if you have existing anxiety or mood disorders a mental health professional can help you to manage these, as stated by The Australian Pain Society.
Self-management strategies
Now what if you don’t have access to professional mental health support right now? Below are some self-management tips:
Free ‘Pain Course’: The free ‘Pain Course’ by Macquarie University helps provide practical skills for pain management as well as your emotional wellbeing
Relaxation techniques: Relaxation can assist you alleviate stress and anxiety, and can also help reduce pain as research indicates in the Journal of Psychosomatic Research 2019 and the Journal of Multidisciplinary Healthcare 2021. Mindfulness, progressive muscle relaxation and breathing exercises are strategies you can do yourself. You can use a variety of websites and/or audio downloads to guide you. One example can be found: https://www.beyondblue.org.au/get-support/staying-well/relaxation-exercise s
Resources used
1. Pelvic Pain Foundation of Australia - https://www.pelvicpain.org.au/understanding-long-term-chronic-pelvic-pain/
2. Journal of Pain Research 2020 -https://www.researchgate.net/publication/341496762_Predictors_of_Psychological_ Outcomes_and_the_Effectiveness_and_Experience_of_Psychological_Interventions _for_Adult_Women_with_Chronic_Pelvic_Pain_A_Scoping_Review (Brooks et al, 2020).
3. Journal of Pain Research 2019 - https://pubmed.ncbi.nlm.nih.gov/31114304/
4. Investigative Urology 1987 - https://link.springer.com/chapter/10.1007/978-3-642-72735-1_19
5. Journal of Physical Therapy 209 https://pubmed.ncbi.nlm.nih.gov/25035267/ https://www.wmhp.com.au/blog/stress-anxiety-pelvic-pain-a-challenging-combination
6. The Journal of Clinical Obstetrics & Gynecology 2020 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340718/
7. Contemporary Clinical Trials Communications 2020- https://www.sciencedirect.com/science/article/pii/S2451865419302777
8. Journal of Physical Therapy 2011 n - https://pubmed.ncbi.nlm.nih.gov/21835893/#:~:text=Pain%2Drelated%20fear%20is% 20the,and%20behavioral%20 responses%20to%20pain.
9. Journal of Multidisciplinary Healthcare 2021 https://www.drsusanevans.com.au/wp-content/uploads/2021/07/Brooks-T-et-al.-jmdh14-1725.pdf
10. The Australian Pain Society 2021 - https://www.apsoc.org.au/PDF/Position_Paper/20210421_APS_Psychology_Position _Statement_Third_Edition_APR21.pdf 11. Journal of Psychosomatic Research 2019 https://www.sciencedirect.com/science/article/abs/pii/S0022399919304295
Angie is a psychology honours graduate and aspiring psychologist wanting to use her lived experience to work within the pelvic pain space
