Psychological Factors in Female Pelvic Pain

An article addressing the fear-avoidance model (FAM) of chronic pain as it relates to female pelvic pain appears in the October issue of Physical Therapy. The FAM, in simple terms, aims to aid understanding of why some people recover from an injury, whereas others may respond with "exaggerated pain perception." Patients who develop chronic pain, according to the model, are in a state of fearful avoidance of the pain which leads to decreased mobility and further challenges in perceiving the pain appropriately. Fear, anxiety, and catastrophizing of the pain can lead the patient to thoughts and behaviors that reduce the patient's ability to recover from the injury.

The authors cite a recent survey of physical therapists who treat pelvic pain and it was noted that these therapists did not employ any specific coping strategies for pain. The authors further recommend that therapists who work with women who have chronic pelvic pain should offer patients education about the psychological components of the pain. This can include teaching the patient that hypervigilance of pain response is not a helpful coping strategy, and that the fear and anxiety related to the pain are important pieces of the therapeutic puzzle. Options for helping the patient reduce anxiety can include relaxation training and helping the patient modulate the return to potentially painful activities.

Screening tools can be utilized as part of the pelvic rehab professionals intake forms, and referral to the appropriate provider for psychological support can be made if needed. The pelvic rehab provider can also include in her treatment plan strategies such as education, relaxation training, activity modification, and coping skills (components also included in cognitive behavioral therapy per the authors.) The study concludes that physical therapists can provide valuable screening of women who have chronic pelvic pain who may also present with fear and avoidance of the pain. This may lead the therapist to modify her treatment plan to include strategies to help the patient reduce the fear-anxiety-avoidance and/or to refer the patient to an appropriate professional for psychological support.