Female Chronic Pelvic Pain and the Mind

What are the spontaneous mental images that women who have chronic pelvic pain report, and how might the positive or negative mental images relate to chronic pelvic pain? These questions are the focus of research published by authors from the UK in the journal Pain Medicine. Mental images are distinguished in this study from thoughts, or thinking in words, as mental images are "cognitions with sensory-perceptual qualities." These qualities are often visual, and may also be related to smell, touch, taste, and hearing. Ten women were interviewed, 8 of whom had a diagnosis of endometriosis or adenomyosis. The researchers explained that they wanted to learn more about the women's thoughts when in pain, and asked about any images that popped into their heads when in pain. Researchers asked other questions about images related to specific categories, while attempting to avoid offering any leading words during their interview. The patients' most significant mental image (chose by the patient) was then explored for content, triggers, related emotion, meaningfulness, activity impairment, and related behavioral changes.

Other data collected included the Brief Pain Inventory short form, the Pain Catastrophizing Scale, the Spontaneous Use of Imagery Scale, the Hospital Anxiety and Depression Score, and the Mini-International Neuropsychiatric Interview. The range of pain duration in the subjects was 3-20 years, with a mean age of 36.2. While every one of the ten women reported that pain was a trigger, other triggers for a negative mental image included movement, social gatherings, exercise, babies, anxiety, sex, sleep, talking about pain, and reminders of surgery or menstruation- in other words, common daily activities or experiences. The content of the most significant mental images included being raped, having "malicious demons" playing around the pelvis, bright lights in an operating room, being terrorized, feeling sad, helpless, anxious, angry, panicky, guilty, disgusted, horrified, and revulsed. The associated meanings were usually also quite negative in nature. The women reported active avoidance of the triggers when able, limiting activities such as social outings or physical activity. Positive or "coping" images were also reported, with images such as putting the pain into a box, mentally "rubbing pain" medication on the body, or imagining a loved one.

What does this information have to do with pelvic rehabilitation? This study utilized a cognitive-behavioral (CBT) framework, and aspects of CBT are tools that rehabilitation professionals utilize in daily practice. Simply put, a cognitive-behavioral approach addresses how a person's thoughts and feelings affect behavior. In rehabilitation, research studies have described how CBT is utilized in the physical therapy setting, and how therapists can be trained to use skills in CBT to help patients . We can engage patients in conversations about what negative images may be impacting movement, and what positive images may be utilized as healthy coping strategies. For more information about the mind and patient education, join us at Carolyn McManus's continuing education course Mindfulness-Based Biopsychosocial Approach to the Treatment of Chronic Pain which takes place next month in Seattle.