Pelvic Pain: Beyond Diaphragmatic Breathing
By Paige Genova
Pelvic Health Occupational Therapist, PRT Therapist
Now, don’t get me wrong. I love teaching my patients diaphragmatic breathing as a tool to help stimulate their vagus nerve and “downtrain” their nervous system. However, it is just a small piece of a bigger puzzle when it comes to pelvic pain treatment interventions. For a subgroup of people dealing with pelvic pain, they have what is called “Neuroplastic Pain.” In order to effectively treat neuroplastic pain, you will need more than just autonomic nervous system regulation. This is where Pain Reprocessing Therapy (PRT) can be a great addition to your toolkit.
First, let’s go over what neuroplastic pain is. Neuroplastic pain is a type of chronic pain that is not due to structural or tissue damage. Put simply, it is when the brain misinterprets normal signals from the body (joint compression, muscles contracting/relaxing, pressure, etc.) as dangerous, thus generating pain. It is a habitual mistake the brain can learn and become familiar with over time, which is why it is called “neuroplastic.”
In contrast, structural pain occurs when there’s an injury/physical problem in the body, and the brain accurately perceives these danger signals. The brain generates pain to tell us something is wrong, which needs our care and attention. This helps us stop, diagnose, and treat the structural problem.
Often in the pelvic pain population, there may not be a structural problem or injury, but you may have seen a clinician that identified musculoskeletal dysfunctions (tension in the pelvic floor, hip rotation limitations, etc.) It is important to note that you can have primarily neuroplastic pain/symptoms AND have musculoskeletal contributors that can be addressed to help treat your symptoms, even in the absence of an injury or structural damage.
If all this sounds familiar and you feel like you’re on a roller coaster of symptoms, rehab, and exercises, Pain Reprocessing Therapy may be a route you want to consider! So how do you know if you have neuroplastic pain?
Let’s take a look below:
Signs the pain/symptoms may be neuroplastic and not primarily coming from musculoskeletal dysfunction or structural problems:
- Symptoms began without injury
- Symptoms began during a time of high stress
- Symptoms are inconsistent (move/spread, delayed, don’t follow a pattern, etc.)
- Lack of physical diagnosis and all medical concerns have been ruled out through testing, labs, imaging, etc.
- Multiple pain/medical conditions that are unrelated but occurring simultaneously
- Symptoms are triggered by factors that have nothing to do with the body (i.e., stress, activities, time of day, weather, etc.)
- History of childhood adversity
As we’ve explored, neuroplastic pain presents a unique challenge, often divorced from structural issues, making its identification and management a specialized task. Now, let’s circle back to the initial query: What if you find yourself on a seemingly endless roller coaster of symptoms, rehabilitation efforts, and exercises? This is where Pain Reprocessing Therapy (PRT) emerges as a beacon of hope in the realm of pelvic pain treatment.
PRT operates on the premise that neuroplastic pain is a misinterpretation of the brain. By addressing the learned misinterpretations in the brain, PRT seeks to rewire these neural pathways, providing a path towards lasting relief.
The biggest (and most important) distinction between “calming down” or “regulating” your nervous system and PRT, is that PRT recognizes the existence of neuroplastic pain, and the understanding and belief in neuroplastic pain, are a key part of the healing process. When you are taught autonomic nervous system regulation but aren’t taught about the pain, able to take the fear out of your symptoms or given the confidence that your pain is neuroplastic, it’s quite rare that the pain goes away entirely. This is because you’re still quite scared or fearful that something is wrong or dysfunctional.
Other mind/body regulation techniques are about “pain management,” and PRT is not about management, but the elimination of pain symptoms.
If neuroplastic pain and pain reprocessing therapy pique your interest, you can find a practitioner list here to work with a specialist.
There are four different categories to choose from:
1. Medical Provider Directory
2. Manual Therapist
3. Mental Health Clinician Directory
4. Health Coach Directory
If you’re looking for pelvic floor specialists who also understand and are certified in PRT therapy, come work with our pelvic floor PTs and OTs at Vital Pelvic Health and Wellness in Eastern Ohio.
If you aren’t within driving distance of our clinic and would like to work virtually with a certified PRT therapist, send me an email.