I’ve been fascinated with chronic pain since I was a little kid. Like many clinicians who specialize in chronic pain, I have multiple family members who experience long-term, sometimes debilitating pain.
To state the obvious, this really sucks. As a kid, I had questions. I still do.
If you’re someone who has a long term relationship with pain, you know that this road is a vibe. Not always a great one.
This is especially true if you have a chronic condition (cancer, endometriosis, interstitial cystitis, adenomyosis, Ehler’s Danlos Syndrome, etc. etc.) that creates physical conditions for pain. The truth is that there may always be something to manage.
But you’re not doomed, either. Let’s get into it.
Here’s the tl;dr:
Pain is a phenomenon that is entirely mediated in the brain. Your brain is simply letting you know that there’s a threat happening — that it’s not safe out there. My favorite description is that pain = sensation + fear.
Neuroplastic pain is an extremely common type of chronic pain defined by changes in the brain that create a sensitive environment to sensation, which begets more pain. Acute pain occurs when there is active tissue damage occurring, like when you step on a nail or there is an active disease process.
Many diverse conditions — from MS to endo — are in fact creating real-deal tissue damage that is worthy of your brain shouting from the rooftops. But more often than not, folks are experiencing both types of pain. If you can manage the neuroplastic pain and create a robust plan for resilience, you’ll handle the acute pain much more successfully.
The deep dive:
I’ve written about neuroplastic pain extensively before (I def recommend this article if you’re struggling with an old injury/orthopedic woes). But here’s the quick shakedown: Pain is the body’s response to danger. If you fall and break your ankle, it is really helpful to know that your ankle is broken, and you’ll likely need to protect the joint while it is healing. Pain is a hero in this way.
Similarly, if you begin to have excruciating pain with your period, it’s helpful to know that your body might be riddled with endo. Pain — a hero.
A lot — and I mean a lot — of pelvic pain has no good medical explanation. Yes, there is often ample muscle tension, but there’s no specific disease process at play. When this happens, it’s a sign that the body is freaked the fuck out — that the brain has become sensitized to sensation in this area of the body and is interpreting any input as painful. Pain has now become a big asshole.
The most effective way to treat neuroplastic pain is to retrain your brain and nervous system. We want to create an environment where your brain no longer considers anything and everything to be a threat. Instead of a hyper-vigilant rescue dog howling at the mailman and every person walking by, we want to train your brain to be the chill AF dog who sleeps most of the day but will still bark appropriately if the doorbell rings at 3 am.
But what if you do have an ongoing condition? In the trainings I’ve taken on pain education and reprocessing, there is often a breakdown between neuroplastic pain conditions (most back pain, lots of unexplained pelvic pain, headaches, etc.) and conditions that are inappropriate for pain reprocessing therapy (PRT), including fractures, tumors, and active infections.
I think there’s a funky and important middle ground. A place where there’s a lot of crossover. Conditions like endometriosis, Ehler’s Danlos Syndrome, lichen sclerosis, and adenomyosis are all chronic conditions that create tissue damage over time (in no way is this an exhaustive list).
It’s really fucking scary to live in a body knowing that you can expect progressive damage over time. Even if you receive effective interventional treatment (e.g. successful excision surgery for endo) there is still a chance of recurrence — and that shit is real. It’s so valid to have these feelings.
And. That fear is exactly the kind of barking rescue dog energy that creates a high amount of neuroplastic pain. You can actually have a significantly improved experience in your body if you tend to the sweet pup barking in your brain.
Here’s how to do it: Your proverbial rescue pup needs to understand that every pedestrian walking by the house is not a burglar. In order to prove this, you kind of need to hang out with the pedestrians, which in this case are sensations. Whether it’s specific movements, fabrics, touch, or other inputs, the goal is to slowly introduce everything through a lens of safety, and slowly build up. This is where it’s super handy to have a pelvic floor therapist or coach trained in chronic pain — because it’s a lot of fucking work to create safety (and then push yourself!) when you’ve been living in a body that has felt not-so-safe for X amount of years. Support is critical, and you’re worthy of it.
If support isn’t accessible right now, the next best thing you can do solo is to invest in positive somatic sensations. If you’re wondering wtf I mean by that, I mean invest in feeling good — like, you know when you’re so calm that your voice drops? That level. This looks different on different people, and it’s important to consider both macro and micro strategies. For example, a macro strategy could be a nightly bath or a weekly dinner date or cutting down on work. Micro strategies — my favorite — often rely on sensory input, like whipping out your favorite essential oil, putting on the softest things you own, or listening to ultra chill vibes.
If it feels so good that you kind of think you don’t deserve it, then that’s it! Good job! Keep going!
The idea is that obvs, you do deserve all of those things. By inundating your body and brain with safe, gorgeous sensations, it reduces the stress load and makes your brain more resilient and less hyper-vigilant. Lean in to feeling comfy AF.
Here’s the take-home:
One thing that really irks me is this idea that we can “cure” pain. While it’s possible for true neuroplastic pain cases, it’s just not always possible, especially in the case of chronic conditions.
In my work coaching clients with chronic pelvic pain, I frequently say that I do not judge success based on how little pain you experience. Success is how much resilience you have — how adept you are at effectively utilizing tools when pain does arise.
The dirty secret is that those two things often go hand in hand. It’s totally possible to experience far less pain, even with a chronic and/or progressive condition.
As always, I am rooting for you. If you’re on the struggle bus right now, I see you — you’re doing a great job. Get yourself a hot water bottle and a delicious snack.
If you’d like to work with me as a coaching client, or have a question, please reach out. I love hearing from you. You can contact me at cait@ritualpelvichealth.com.