By Jessica Newman, LMHC
Living with persistent pelvic pain is, by definition, painful physically. What can be hard to talk about (especially for folks with pelvic pain) is just how emotionally distressing the pain is. And because the mind and body are a functional whole (think: a Mobius strip) emotional distress can trigger or amplify physical pain and vice versa. The good news, however, is that you can learn to use the intimate feedback loop between body and mind to feel better both physically and emotionally.
Here are some ideas clients have found helpful in coping with their pelvic pain.
- Learn about the physiology of chronic pain
Pain can be a shape shifter-some days better, some days worse. This uncertainty contributes to feelings of anxiety and being out of control. When people have less of sense of control they tend to feel more stressed, which usually increases physical pain. Having accurate information about the physiology of pain can restore a sense of control. Even when the pain is worse, it makes sense why it’s there. This alone has been shown to reduce emotional suffering and increase people’s sense of their ability to cope. The work of David Butler and G. Lorimer Moseley is generally considered some of the best information about this topic.
- Learn to elicit the relaxation response
Most folks have heard of the stress response of fight, flight, and freeze and know it can increase pain. Fewer people know that we all also have an inborn relaxation response- the natural counterbalance to the stress response.
You can learn to elicit the relaxation response through meditation, prayer, visualization, yoga, or t’ai chi, as well as more everyday activities like coloring, petting your pet, or repetitive physical tasks like knitting or chopping. Choose a few ways that work for you at different levels of distress. For example, many people find it very hard to use methods where you “go inside” with your attention when pain is intense (e.g. meditation). In these moments, eliciting the relaxation response by putting your attention outside of your sensations, or using distraction, is often helpful.
- Identify your triggers and recognize that flares can occur because of “trigger stacking”This is the same idea as learning about pain physiology. Increasing a sense of predictability contributes to a sense of agency and control, which tends to help us feel more capable of dealing with difficult things. Triggers can be physical (exercise, sitting, sex) or emotional/cognitive (stress at work or home, the thought, “Uh-oh-here’s the pain again, I can’t handle this.”) It can help to keep a diary or log while you are still learning about your triggers. Be aware that it may not necessarily be that a particular event or activity always causes symptoms, but rather, “trigger stacking”-i.e. you would feel ok if you had a stressful day, or ok if you had sex, but if you had a stressful day, had sex, and were feeling particularly unsupported by your partner, then you might have greater symptoms. Knowing your triggers can help you predict how you’re going to feel, and return to you a sense of choice about which activities to do when. For example, if you know that sex and exercise can both be triggers, you might choose to do one on one day and one on the other, with some time in between, and/or increase your relaxation or other positive activities on a day when you know you’ll have multiple triggers.
- Get as much support as you can
In general, the more stress we are under, the more support we need to cope. This isn’t a reflection of personal strength or weakness, but rather a general truth about being a person. It can be especially helpful to get support from other people with chronic pain as they can, “get it” in ways that people who haven’t experienced chronic pain haven’t.
- Don’t try to push against the waves
One of our first responses to pain, whether physical or emotional, is to tighten up against it, reject it, and try to ward it off. This is a natural response to unpleasant situations. And yet, this is like being at the beach and stiffening when we sense a big wave coming at us. Paradoxically, when we stiffen, the wave crashes into us very hard. Whereas when we roll with the energy of the wave it washes over us and we are less buffeted. Just like waves, our emotions and sensations are changing. If we can learn to move towards them with acceptance, even the ones we strongly dislike can become more tolerable. This is easy to write about, but hard to do in practice. Therapy can help, as can mindfulness practices such as this one.
- Avoid avoidance
When we are in pain, we (unsurprisingly!) tend to stop doing activities that hurt. This is called the pain/avoidance cycle. It is imminently logical and can be part of a good short-term solution to a pain flare. As long-term solution it can turn into a double whammy: we’re in pain and not doing things we enjoy. This can lead to more negative emotions, which can then make pain feel even worse. Avoiding avoidance is not the same as “sucking it up” or ignoring your pain. Rather the idea is to practice tolerating (rather than rejecting) some pain and even some small acceptable increase in pain for the benefit of feeling more connected to things that are important to you in your life. This idea often feels overwhelming to people because of how scary pain can be. If this is true for you, you may wish to seek the support of a therapist who can help you make this feel more approachable by breaking things into smaller steps and pieces.
- Name your feelings with kindness
When you are having an especially hard time, it can be helpful to simply name and acknowledge your feelings-“I’m feeling really scared right now”; “I’m really angry that I have to work so hard to feel well.” Naming feelings tends to put a little healthy distance between us and emotions that might otherwise feel overwhelming. It can also help to think about how we would talk to a friend or a young child who was having the same experience-usually we are much kinder and gentler, which can really help when we’re hurting.
- It’s the thought the thought that counts
Thoughts aren’t just abstract mental events. They have a real impact on our emotions, physiology, and our actions. For example, if I think, “I’ll never get better” it might make it hard for me to go to PT or to learn relaxation, which in turn would actually make it hard for me to feel better. Conversely, the thought, “I’m feeling hopeless right now, but I know that I feel a bit better if I even do 5 minutes of relaxation” can encourage me to do just that and feel a little better. Learn which thoughts tend to increase distress (e.g. “I can’t handle this”) and practice “reframing” them in ways that tend to help you feel more resilient. Partners and friends can help with this, as can therapists.
- Increase positive activities and things that give you a sense of mastery
Whenever we’re coping with a strong negative situation, it helps to try to counterbalance this with positive activities. You can think of this like a bank account-if experiences of pain are making a lot of “debits” on your account, it’s important to try to make “deposits” of good experiences.
- Set small goals and celebrate successes
Recovering from and coping with chronic pain is not a linear process. Taking time to highlight and celebrate your successes can help sustain you. This is particularly helpful to do during a flare when people often lose sight of their progress. If you can’t remember, which can sometimes happen, ask a partner, a friend, or even your physical therapist when you’re there, to remind you. Sometimes people also find it helpful to write down their progress so they can look at it when they’re feeling hopeless or having a setback.
I know that when you are in chronic pain it can seem like you’ve always felt this way and that you will always feel this way. In reality, chronic pain can get better, and, unbelievably, you can learn to feel better, even if pain stays part of your life. Just take it one small step at a time. If you think you’d like to work with a therapist about these issues, I welcome you to reach out to me at: firstname.lastname@example.org.
About The Author
Jessica Newman, LMHC is a psychotherapist in private practice in Cambridge, MA. She received her Master’s in Counseling Psychology with a Holistic Specialization from Lesley University, where she is now an adjunct professor. Jessica’s approach to counseling blends a warm, supportive relationship with practical skill building to help people manage anxiety, depression, trauma, life stressors and transitions. You can read more about Jessica and her approach here.