Chronic Pelvic Pain
There are several types and causes of chronic pelvic pain, which include:
• Chronic tension/spasms in pelvic floor muscles
• Chronic pelvic inflammatory disease
• Irritable bowel syndrome
• Interstitial Cystitis (Painful Bladder Syndrome)
• Pelvic congestion syndrome
• Polycystic Ovarian Syndrome
• Ovarian remnants
• Dsypareunia (pain with intercourse)
• Dysmennorhea (pain with menstruation)
• Penile, testicular, perineal (prostate) pain
• Vulvodynia (clitoral, vaginal, vulvar burning/pain)
• Post-operative or post-partum pain
Frequently, patients with chronic pelvic pain have experienced pain for years and been seen by dozens of doctors and specialists in an attempt to understand and treat their symptoms. Once a patient has been in pain for this long, the nerve pathways that transmit pain often become sensitized (a process called central sensitization), and the patient’s symptoms become increasingly complex with a mix of pain symptoms, anxiety, low mood, poor sleep and fatigue. When symptoms are severe, individuals may be unable to participate in social or leisure activities, find it difficult to continue working, and experience a loss of intimacy in their relationships, which ultimately compounds their suffering. Contributing to feelings of isolation and distress is that chronic pelvic pain is often seen as a taboo topic, not suitable for easy conversation with coworkers, family, or friends.
Psychological factors such as mood, beliefs about pain, and coping style have been found to play an important role in an individual’s experience of, and adjustment to, chronic pelvic pain. Also, depression, chronic stress, or a history of sexual or physical abuse may increase a person’s risk of developing chronic pelvic pain. Because psychological factors can have an impact on the experience of pain, however, does not mean that the pain is “all in your head” or not real. We believe that a large majority of people who report pain are really experiencing it, even if a physical cause has not yet been identified. Ultimately, it boils down to the fact that emotional distress makes pain worse, and living with chronic pain contributes to emotional distress.
What to Expect Your First Visit
Your first visit consists of a psychological pelvic pain evaluation. Please bring your ID and insurance card with you. You will meet with a health psychologist for a full clinic interview to go over your pelvic pain condition, medical history, and how your pelvic pain is affecting your life. You will also complete a series of psychological tests. These are paper pencil tests in our office and there is no time limit. You may be mailed a packet of these tests prior to your appointment. If you could complete this packet and bring it to your evaluation, it would shorten the length of your appointment. There are other tests that will have to be completed in the office. Some of these tests have general psychological questions that may seem unusual. Please just answer them to your best ability. Please bring your reading glasses. If you have difficulty reading, we have some of tests on audio, or you could have a friend or family member assist you with the completion of the test.
The health psychologist will take the information from talking to you, your psychological testing, and your medical records to compile a psychological pelvic pain evaluation. This will include treatment recommendations for your benefit.
One particular psychological treatment approach that has been found to be highly effective in helping patients to reduce the pain, disability, and distress associated with chronic pelvic pain is Cognitive Behavioral Therapy (CBT). CBT for pain management is tailored to the individual needs of the patient but may include:
• Relaxation Training
• Cognitive Restructuring
• Stress and Anger Management
• Sleep Hygiene
• Activity Pacing
We believe it is important to empower our patients by providing a thorough knowledge base about their conditions and encouraging them to embrace all components of their journey towards recovery. Each patient must be willing to become a partner in their care and share responsibility for the outcome. It is critical to recognize that you have a complex condition that is likely to require time, consistent therapy, and commitment to a specific treatment plan to achieve lasting relief. Ultimately, this recognition lessens anxiety and promotes the body’s ability to heal.
Treatment sessions are about 45 minutes for 8-10 sessions