Learning about the science of persistent pelvic pain

by Millie Mardon

Have you ever practiced a skill – something you were once not so good at – but practiced really hard so you became better at it? Have you ever become so good at a skill you no longer have to think about how to perform it anymore, you just do it? Your brain and your nervous system do similar things when it comes to ‘learning’ pain.

Pain is a really important survival mechanism. Without it, we would always be hurting ourselves. Pain is 100% of the time made in the brain. However, just because pain is something that involves the brain and nervous system does not mean that it is ‘all in your head’ – pain is 100% real, 100% of the time. We experience pain when our brain thinks we are in actual or potential danger, and therefore need protecting. To do this, our brain weighs up many different factors to decide whether we are in harm or not – a balance of safety versus threat. When the amount of threat outweighs the safety, we often start to feel pain.

Persistent pain occurs when we experience pain for a long time (usually over 3-6 months), and our brain still believes our body is in danger and therefore needs protecting. When we have pain for a long time our brain and nervous system become really good at perceiving pain. We form neural networks specifically dedicated to the task, like when we learn a new skill, and this keeps getting stronger the more we feel pain. As a result, our bodies become more sensitive to various stimuli that may influence our pain.

When someone experiences persistent pelvic pain, the amount of pain someone feels is rarely proportional to what is going on in our tissues and organs. For example, someone with stage 1 endometriosis can experience significant pain, whilst someone with stage 4 endometriosis may go through life without any pain whatsoever! Persistent pelvic pain is not only influenced by things in our bodies (like endometriosis, inflammation and hormones), but it is also influenced by our thoughts, feelings, words, and relationships. All these things can increase our brain’s ‘danger dial’. It is important to note that everyone has an individual experience of pain, so different factors may play a role to different people, and this is why it is so important everyone’s pain is managed individually.

It may seem a little daunting finding out about the many different things that can influence our pelvic pain. But the good thing is, this means there are many different ways we can manage it! Management strategies might include medication or surgery, others may be seeing a psychologist to try and challenge our thoughts and worries about pain, or trying meditation, or exercise. All these things can decrease the amount of threat our brain perceives, and we often have to try multiple things at once. Finding the right pelvic pain management strategies is important because it can help us ‘re-wire’ those neural networks involved in pain – just as our brain and nervous system become good at ‘learning’ pain, they have the ability to ‘unlearn’ it too! Persistent pelvic pain can improve, and learning more about your pain is one step towards that improvement. It is important to discuss this with a health professional trained in persistent pelvic pain (e.g., pelvic physiotherapist) so you can learn more about your own body and make an individualised pain management plan.