You are crazy, you aren’t smart enough to understand . . . . it’s all in your head. . . it’s not real . . .

These are all things I have heard recounted to me by patients, in tears usually.  Other medical couldn’t detect it, so the easiest thing is to say ‘sorry does not exist aka you crazy!’  

Well a man named Lorimer Moseley wrote a book called Explain Pain where he says the pain is real, and it is in your head ( somewhat), but you are NOT crazy . . . . . intriguing, no?

Here is a quick analogy: Imagine your brain is a thick dense forest and there are signals moving all over the brain all the time.  Using the example of a hand on a hot stove.  

So there is a part of the brain-forest that detects the pain stimulus and sends it to a part of the brain to understand that ‘ouch something hurts’ and remove hand from hot stove- right?   Now normally this pathway is really fast- I mean microseconds from point A to point B.

Well what happens if point A lights up point B, C, D M, N, Z and the brain then perceives pain in your hand, but also your shoulder, elbow, knee, and stomach?  And as time goes on, this new, dysfunctional pathway becomes stronger, faster, and lights way up.

With chronic pain, what was once an efficient pathway, becomes a mess and the brain gets confused and detects pain in all sorts of confusing ways.  Are you crazy? NO.  Is the pain in your brain?  Somewhat.   Your ability to perceive and detect pain in skewed.

Now how does surgery work?  Surgery ideally fixes the damaged tissue/ organs so that the stimulus stops.  Will that change this new pathway? 

How does pain management work?  Medication is given to dull the stimulus so that the brain stops perceiving so much pain and hopefully dull that pain pathway.

How does pelvic floor physical therapy work?  We try to heal the tissue and change the brain’s perception of pain.  As a PFPT I try to guide my clients through a small pain free range, and slowly build up their tolerance to more.  We may start off really small.

For example, if you have pain when sitting we may start you off in a sitting position, but lying on your side- so hips and knees bent to 90 degrees.  Pain with sex?  We can work externally first, then internal work, then add in dilators etc . . . the list goes on! 

Is one treatment better than the other?  Depending on your case, yes- it may be one treatment is better but it may also involve more than one treatment at a time.  

Also pain and the brain are a funny thing! If you are stressed, tired, sick-  your pain will be worse!  If you are depressed, you will perceive your pain as worse.  If you have coping mechanisms you will do better!  Physical therapy is a great way to start to unravel pain in the brain.  It does take time and patience, but with a good provider/ team- it is doable!