Chronic Pelvic Pain: How to Transform and Heal
Authored by Dr. Maryssa Steffen, PT, DPT, Board-Certified Pelvic Health Clinical Specialist
“Mindfulness is defined as present-moment, nonjudgmental awareness. By reducing self-criticism, and depression, and increasing self-compassion, attention, and interoceptive awareness, mindfulness has been found across a variety of systematic reviews and meta-analyses to significantly improve sexual desire, sexual pain, and sex-related distress.” (Mindfulness and Management of Low Desire and Vulvovaginal Pain)
How can somatic practices help those living in pain?
Playing with the somatic principles of interoception, exteroception, and proprioception not only develops awareness and can enhance pleasure, but they can also modulate the sensations, emotions, and responses to environments associated with pain.
Somatic practices connect you to your senses and can support the self-management of your symptoms through changing behavior and exploring options.
What do you need to support turning your attention inward?
How can your environment support turning your attention inward?
What options do you have that may increase your capacity to bring your attention inward?
When you turn your attention inward, you may notice a shift in your curiosity and creativity of movement.
Repeatedly practicing somatic approaches to movement improves the awareness of body signals, improves the self-management of symptoms, and offers resources to explore fear and pleasure of movement. Also, you will understand how social environments impact the pain response.
How is interoception connected to self-regulation?
Interoception increases your capacity for self-regulation by connecting you to the moment, and by increasing the flexibility and resilience of your nervous system’s response to stress.
“Interoception is bound up with awareness of and modulating chronic pain experiences on multiple levels, often providing prompts for action such as discomfort or tiredness as cues for changing activity.”
How do somatic practices modulate pain?
Fundamentally, these practices bring your attention to the internal movement of breath. When you breathe, how do you know you are breathing? What sensations inform you of the quality of your breath? How deeply can you perceive this? What is this like for you?
Breath promotes relaxation. Your breathing controls the effects of your fight/flight responses in times of stress. Somatic approaches can enrich your breathing practice by moving your focus to different parts of your anatomy, such as your skin, bones, and visceral organs.
Somatic approaches to movement invites your own personal movement research as you more clearly attend to your body awareness and your responses.
You have the power to change your tense, habitual responses to pain.
The Committee on Pain, Disability, and Chronic Illness Behavior note that “stress and anxiety increase muscle contraction and would thus be expected to exacerbate any pain problem…Conversely, any treatment that induces relaxation will reduce muscle contraction and perhaps lessen pain.”
Interoception can fundamentally support how you track the ongoing effects of pain, including your emotional states or social situations associated with your symptoms. Further, it offers the possibility of playing with different ways to respond to these parts and layers of your experience.
What are habitual responses to pain?
Your sensory-motor system is always responding to daily stresses and traumas
Unconscious, muscular contractions
These reactions are fast
Your muscle memory moves quickly to protect you, especially when you are afraid of the pain
These habits add to your pain
Would you like to speak with a trauma sensitive pelvic pain specialist or a therapist who focuses on pelvic health to learn more about somatic approaches to physical therapy? Book a discovery call here!
What if interoceptive attention aggravates your symptoms?
Yes, it is possible that interoception may heighten focus on painful experiences. Perhaps consider how to “understand how to skillfully relate to interoceptive sensations, and under what circumstances they should be attended to.”
You can start by asking yourself your capacity to play with interoception. Are you rested? Are you curious? Do you have privacy to explore emerging, felt, self evolving material? What is your relationship to emotional resourcing and mental health support?
You may benefit from working with a trusted professional who is sensitive to persistent pain and trauma and who uses body based treatment modalities to support your journey to feeling at home in your body again.
What is pain?
The International Association for the Study of Pain, IASP, has a core definition that states that pain is “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.”
Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors.
Pain and nociception are different phenomena. Pain cannot be inferred solely from activity in sensory neurons. (In other words, pain can be perceived without “tissue damage.”)
Through their life experiences, individuals learn the concept of pain.
A person’s report of an experience of pain should be respected.
Although pain usually serves an adaptive role, it may have adverse effects on function and social and psychological well-being. (It once served a protective purpose, but may now be a dominant and unconscious response to stimuli.)
“Verbal description is only one of several behaviors to express pain; inability to communicate does not negate the possibility that a human or a non-human animal experiences pain.”
The IASP definition of chronic pain states that it is pain that persists or recurs for longer than 3 months. If your back initially hurt 10 years ago, and it hurts again in pregnancy, you may be experiencing chronic pain.
So, what is the good news???
The science of neuroplasticity explains how our brain changes throughout our life. Pain is the “loyal soldier” of neuroplasticity because when the experience of symptoms lasts for longer than three months, our nervous system, immune system, and endocrine systems all adapt to respond to pain faster and with more sensitivity. Your brain is trying to solve a problem for you!
From a somatic perspective, people with chronic pain can be seen as “active producers of meaning rather than bundles of recalcitrant symptoms or medical mysteries.” Your body is telling you something. It may be holding layers to a story you have yet to attune to.
Somatic approaches to therapy may offer validation to your experiences which may be otherwise challenging to describe.
Rather than simply saying, “I am in pain,” what is it like for you to try explaining it, or expressing it, with other words? Are there other qualities such as textures, weights, speeds, emotions, images, meanings, contexts, sensations, urges, etc. that are present?
Pause. Notice what shifts in you when you inquire about your body in this way.
You have somatic authority.
This is the beginning of process-oriented transformation.
What is an example of a somatic movement practice that has a curriculum and has been researched?
Body-Mind Centering® is “an integrated and embodied approach to movement, the body and consciousness,” developed by Bonnie Bainbridge Cohen.
In this practice, you can play with the sensations within muscles such as their movement, their mobility, tension patterns, and how they release.
You can linger in the weight and fluidity of your organs as you roll out of bed in the morning.
You can inquire about the discomfort of pain, and play with other movement options that may be inspired by your own anatomical research and the embodiment of your early movement development and embryology.
There are many ways to source movement, and practicing any of these approaches can train your mind to interrupt the pain loop.
If you refer to the last somatic approaches to movement blog, interoception is described as our internal sense during movement.
Noticing body cues with improved accuracy can help to decrease the hyper-alertness to overwhelming pain signals.
Interoception “seems to provide the basis for the subjective image of the material self as a feeling entity, that is, emotional awareness.”
Also recall that the IASP defines pain as influenced by psychological factors, is shaped by our experiences and meaning making, and can be perceived without actual tissue damage.
Therefore, chronic pain must be treated holistically. Interoception may be a potent resource for treatment, as it plays a major role in health and well-being, by linking bodily awareness with “self-image and emotional experience.”
How is your body awareness affected by chronic pain?
“Altered sensitivity to exteroceptive stimuli.”
Unable to discern where in your body is being touched.
Change in perception of the size of your body.
When you attend so much to the pain intensity you can increase your hypervigilant response to pain.
By focusing on the pain repeatedly, your brain can alter your perception of touch and decrease your body awareness.
Hypervigilance can decrease your tolerance to sounds, smells, and tastes.
Less awareness of your muscular effort, decreased balance, and impaired perception of where you are in space (bumping into things).
You may “guard” yourself to protect yourself from the threat of moving. Avoiding movement increases your pain.
How can embodied practices invite a resource to play with when experiencing pain?
Undoubtedly, the discomfort and fatigue resulting from persistent pain or symptoms will affect your perceptions and motivations for movement in space.
Somatic movement practices offer safe and comfortable ways to explore habits and fears associated with movement.
“Slowing down, connecting gently to the rhythm of breath, and visualizing slow movement can be a powerful tool in restoring a sense of ease and capacity to self-manage.”
Somatic movement practices may include:
Movement with breath support.
Safely exploring your body awareness.
Safely exploring your awareness while moving in space.
Gradually tending to your fear of movement, with the guidance of a trusted movement professional with experience helping clients with chronic pain and fear avoidance behavior.
Attend to yourself carefully enough so that movement options that feel different than “pain” may emerge.
Avoiding movement because of fear may limit your ability to test out other possibilities. Over time, you may have less lived experience with disconfirming information, thus perpetuating the pain cycle and avoidance of movement in space.
How can you apply somatics to fear avoidance behavior?
Notice and sense your environment.
What is it like for you to notice how you navigate the structures of your environment?
How do you position yourself in standing, sitting, walking, lying down?
Explore triggers for fear.
Is there a story?
Is there an expectation that narrows your senses and drives your movements?
Develop resources for moving with confidence.
Where in your body do you feel strong?
Is there a position with gravity that is pleasurable?
Is there an environment in which you feel so comfortable that you can linger there and breathe for as long as you desire?
Micromovements are always welcome.
Imagine the movement.
Make it small.
Hold space for breath support as you play with gentle movement patterns.
Slowly increase your confidence with moving in space.
You are the expert of your body.
You have agency and power.
You have the capacity to ask your body what it is telling you.
How do you identify what is supportive to your values and needs?
If you are in the state of California, book a discovery call to learn more about chronic pelvic pain treatment. We offer Telehealth and in person visits. Our office is located in Oakland, CA.
Reference:
Meehan E and Carter B (2021) Moving With Pain: What Principles From Somatic Practices Can Offer to People Living With Chronic Pain. Front. Psychol. 11:620381. Doi: 10.3389/fpsyg.2020.620381
