How Pelvic Pain Becomes Chronic Pelvic Pain: Central Sensitization

“If my doctor’s had more knowledge in pain science or chronic pelvic pain, I’m sure they would have given me the treatment needed to help me find relief and try to prevent me from developing Central Sensitization . ”

If my math is right, I’ve been living with chronic pain for over 15 years. I started feeling pelvic pain symptoms (debilitating cramps, abnormal bleeding, Vulvodynia, chronic urinary tract infections, IBS) around 13 years old.

After years of being wrongly diagnosed, being told nothing was wrong with me and hearing that my symptoms were a ‘normal part of being a woman‘, I sucked it up, pushed through my pain and discomfort, and pretended to be ‘normal’. I stopped complaining about my issues and figured out how to cope with my symptoms.

Looking back, I now know, that approach was probably the worst thing I could have done for my body and mind. I should have stood up for myself and been a better advocate for my health. But, I was young, so I can’t beat myself up about it.

I now understand that my chronic pelvic pain, to some extent, was preventable.

Why?

Because if my doctor’s had more knowledge in pain science or chronic pelvic pain, I’m sure they would have given me the treatment needed to help me find relief and try to prevent me from developing Central Sensitization (I explain below). But the reality is, many doctors aren’t up to date on recent pelvic pain research and treatments so they tell you they can’t find a reason for your pain and escort you out the door. Leaving you alone, with no answers or next steps.

If this is also your experience, you may have wondered at some point, why your body is so sensitive (I questioned it alllll the time.). But you don’t need to worry that you are weak, or that the pain is imaginary. It’s real. Your pain is REAL. And here is why….

Short-term vs. chronic pain:

There is a reason we get pain – it alerts us to the dangers in our environment in order to protect ourselves. And when it comes to pain, there is short-term pain and chronic pain.

Short-term pain is the way our body tells us something is wrong and we should protect ourselves. An example of this is the pain you feel when touching a hot stove, or stubbing your toe, telling you to move away to protect yourself. Likewise, the pain you feel after an operation or injury tells you that you need to rest and allow your body to recover and heal. Short-term pain usually go away over time.

Chronic pain is when the pain doesn’t go away. The original cause of the pain may no longer be there. Infection or tissue damage can be nonexistent. There is nothing that needs medical attention immediately and you are in no danger. Tests may show no abnormalities. Yet, there is still pain.

It is possible that particular conditions, including Endometriosis, may be likely to result in chronic pain. This is because it is known that repeated episodes of severe pain are more likely to lead to chronic pain than a single severe pain episode.11

For me personally, years of Vulvodynia, chronic debilitating UTI’s and painful periods every month, was the perfect storm for developing chronic pain. 

If you have had pain in the pelvis on most days for more than three to six months, it is likely you have chronic pelvic pain.

Why does this happen?

Another term used to describe chronic pain is Central Sensitization. This means the nervous system goes through a wind-up process and gets regulated in a constant state of high reactivity. This process alters the way our bodies and brains perceive and react to pain triggers. The nerve endings can become so sensitive that they interpret any sensation, even pressure or inflammation, as pain.

As nerve pathways change and as they become more engrained in our brains and emotions, it’s much easier for our brains to perceive anything as a threat and continue to send pain signals, getting stuck in a vicious cycle.

Central Sensitization in chronic pain

I attended a Pelvic Pain Program this year and they suggested to imagine the nerve pathways like a ski hill. The more skiers who go down that specific area, the deeper the grooves in the snow will get from their skis. Because of this, following skiers, will be more easily guided down those already deep grooves in the snow. Now imagine each skier as a pain signal and the ski grooves as the pathway. It becomes second nature for your brain to associate any sensation to pain due to the easy access of pain pathways (ski grooves) created by multiple pain episodes (Skiers).

Don’t get me wrong, you may still have conditions in the pelvis that have not been fully treated (Endometriosis, IC, IBD, Crohn’s etc.), so sensitization of nerve pathways may not be your only problem, but is it likely that your nerve pathways are part of it.

Bladder Pain Example:

Without our knowledge, our brains constantly collect information on how much urine is in our bladder. The brain allows us to continue our normal activities and be unaware of our bladder until it is at full capacity. As the bladder fills, more and more messages are sent to the brain due to the nerves firing within the bladder. When full, the brain makes us aware of the need to relieve ourselves. If we don’t go the toilet and the bladder continues to fill, we will start feeling discomfort or pain. Once the bladder is empty again, we are allowed to continue our normal activities without noticing our bladder – until it becomes full again.

If you have Interstitial Cystitis or Bladder Pain Syndrome, there are more pain messages than usual being sent to the brain and we feel the need to empty our bladder more often. More pain messages are sent to the brain because the nerves in and around the bladder are firing due to unresolved pelvic conditions (Pelvic floor dysfunction, Endometriosis, Interstitial Cystitis/BPS, Pudendal Neuralgia etc.) and Central Sensitization.

How years of chronic pelvic pain effect our pelvic floor muscles:

Muscles tighten and tense up when they are injured or when we are in pain. This is a normal response to prevent more damage from occurring. Our pelvic floor muscles tighten up too when there is something painful in the pelvis.

Muscles aren’t meant to be tight all the time and after a while, they start hurting and adding to the already existent pelvic pain. Just like a sore neck from a stressful day at work, our pelvic floors hold our tension and can hurt as well.

We are designed to move, so lying down a lot due to pain can make the pain even worse. Muscles that become even tighter can spasm, causing sudden, stabbing or cramping. These spasms can mimic new painful symptoms, which leads to so many of us thinking something is terribly wrong when we are actually in no immediate danger. This is central sensitization and Pelvic Floor Physiotherapy can help with that aspect.

Why does chronic pelvic pain need to be taken more seriously by general practitioners?

The longer it takes to get to a correct diagnosis, the longer it takes to believe a woman’s pain, the longer it will take them to recover and have a good quality of life.

When pelvic pain becomes chronic, our immune, endocrine and sympathetic nervous systems all get switched on to help us cope. The entire body joins the party. This may help with recovery in short term pain, but when chronic pain is added to the equation, these systems don’t function well and neither do we. Our energy levels, sleep, bowels, concentration, immune system, are affected and life becomes even more challenging.

The best thing a family doctor/GP can do for someone with repetitive pelvic pain symptoms at early onset, would be to direct them to the correct specialist and treatment plan to decrease the chance of them developing chronic pelvic pain and the additional symptoms that go a long with it.

And in order for that to happen, more education and awareness needs to happen. Especially in GP doctor offices.

The journey is long one, especially if you have been battling chronic pain and Central Sensitization for many years, but here are some non invasive ways to help reduce some of your pelvic pain:

  • Finding and working with a Pelvic Floor Physiotherapist who understands pelvic pain and conditions
  • if your doctor is not taking your pain seriously, a Pelvic Floor PT could give you some better insight to your pain generators and advise on next steps
  • keeping your body moving and muscles comfortable
  • learning positive ways to manage your pain (Meditation, yoga, hobbies etc.)

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Ref.

1. Children (Basel). 2016 Dec; 3(4): 42.Published online 2016 Dec 10. 

Chronic Pain in Children and Adolescents: Diagnosis and Treatment of Primary Pain Disorders in Head, Abdomen, Muscles and Joints

Stefan J. Friedrichsdorf, James Giordano, Kavita Desai Dakoji, Andrew Warmuth, Cyndee Daughtry,  and Craig A. Schulz, Carl L. von Baeyer, Academic Editor

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