At the time of this blog post the world is at a virtual standstill. COVID-19 has descended upon the entire night like a thief in the night. We are all living in an unfamiliar world.
For most, it is trying. For those who suffer from chronic pelvic pain, it may be unbearable.
I had the great privilege of sitting down with Dr. Jana Scrivani, a psychologist and cognitive behavioral therapist with Pelvic Rehabilitation Medicine. She specifically treats men and women suffering from chronic pelvic pain, to discuss how living in various stages of lockdown can have a significant impact on pelvic pain.
You can click here for the link to the full interview.
I wanted to know what her thoughts were on the mind-body connection and how it contributes to pelvic pain.
“The mind-body connection is incredibly strong...it is really actually quite a normal experience that excess amounts of anxiety and stress can have an impact on our bodies, and specifically have an impact on our pain levels. The pelvic floor is no exception.”
A vicious cycle is created. Anxiety and stress can cause pain signaling to the brain which increases the feeling of pain. That increased pain leads to even more anxiety and stress, which leads to even more pain signaling.
I asked Dr. Scrivani to describe how exactly do our brains and nervous systems contribute to the pelvic pain experienced during times of stress.
“When we’re talking about the mind-body connection, we’re talking about pain that’s real. So just because we’re gonna talk about how your brain influences your perceptions of pain...it in no way suggests that the experience of pain is not real. It absolutely is.”
She went on to explain how we used to view pain through a model called the Specificity Theory. At one time the medical community was convinced that pain was experienced in a very specific way. If you got injured you felt pain. If two people were injured the same way, it was thought they would have the same pain experience.
For example, if both people had fallen and broken their arms, their experience of pain would be similar.
However, the study of pain science has led the medical community to understand that is not the case. In fact, pain is dependent upon so many factors, culture, age, perception, sensitivity, environment, etc.
Pelvic pain is even more dependent upon these factors as our pelvis is often thought of as our body’s most vulnerable areas. In other words, we have discovered that our psychological connection with our pelvis can shape the pain, or lack thereof, we experience.
Dr. Scrivani offered a more modern model for us to consider when talking about pain. The Gate Control Theory is more complex than the Specificity Theory, but is much more inclusive with regard to the psychological contributions to our experience with pain. In this theory of pain, our brains play a role in how we respond to pain.
Some of the psychological factors that are involved with our pain experience include both the positive and negative emotions we feel, the level of social support we have and even how intensely we focus on the pain.
These factors can open and close gateways that can lead to increased pelvic pain. Learning how to control these factors has indeed been shown to reduce the experience of pelvic pain.
Understanding the psychology of pain is one critical to help manage it. However, Dr. Scrivani and I also discussed how pelvic floor muscles fit into this vicious cycle of pain.
Muscles only know how to do 2 things: Contract and relax. When you are anxious or stressed, your body muscles try to protect you the best way they know how….they contract. Unfortunately, they don’t always know when it is time to release, or they can get stuck in that contracted position. This can lead to increased pain signaling as these muscles are not performing properly.
Then, the cycle begins. The contracted or hypertonic pelvic floor muscles can be sore and painful which can prevent you from doing things that you love, such as taking a walk with friends or enjoying intimacy with your partner. It is likely that you will become more anxious as you are concerned that you are no longer able to participate in the activities that you love. As previously mentioned, your anxiety can increase the pain signaling, which then can lead to even more contraction by the pelvic floor muscle. Round and round it goes.
What can you do to stop the cycle?
Diaphragmatic breathing is a method that both Dr. Scrivani and I recommend that can help you gain control of your emotions associated with your pelvic pain. If you are unfamiliar with how to start, you can skip to 25:03 of this video, or you can watch Dr. Scrivani explain it by clicking here.
Another great way to help you stop the anxiety/pain cycle is to gain control of your body. One method of doing that is to stretch. I recommend the adductor (inner thigh) stretch during the video. Learn how to properly perform this stretch by watching 34:07 of this video.
2020 has been a time of great turmoil. It is normal that you may be feeling more anxious. It is also normal that with that anxiety, you may be experiencing more pelvic pain. The good news is that you can learn techniques and strategies to give you some control of your pain.
Do you have questions or comments? I’d love to hear more about what you think about this topic.