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A Tale of Two Pain States: The Integrative Physical Therapy Approach to the Overactive Pelvic Floor

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Book cover The Overactive Pelvic Floor

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Abstract

This chapter presents a framework for the evaluation and treatment of pelvic pain and the overactive pelvic floor (OPF) from a biopsychosocial perspective. Level 1 evidence supports central pain mechanisms as a key feature of many pelvic syndromes including pain associated with the OPF. The treatment strategies presented in this chapter are designed to address both the pelvic musculature and central pain mechanisms involved in persistent pain. Research supports the therapeutic need to target the nervous system as well as the muscles and joints when treating persistent pain. We present this information with a focus on patient education in current pain science, graded imagery exercises, and integrated mindfulness techniques that are optimal for restoring balance to an OPF.

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References

  1. SparkNotes Editors. SparkNote on a tale of two cities. 2002. http://www.sparknotes.com/lit/twocities/. Accessed 13 Aug 2014.

  2. Phillips K, Clauw DJ. Central pain mechanisms in chronic pain states-maybe it is all in their head. Best Pract Res Clin Rheumatol. 2011;25(2):141–54. doi:10.1016/j.berh.2011.02.005.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Moseley GL, Flor H. Targeting cortical representations in the treatment of chronic pain: a review. Neurorehabil Neural Repair. 2012;26(6):646–52. doi:10.1177/1545968311433209.

    Article  PubMed  Google Scholar 

  4. Pukall CF, Strigo IA, Binik YM, Amsel R, Khalifé S, Bushnell MC. Neural correlates of painful genital touch in women with vulvar vestibulitis syndrome. Pain. 2005;115(1–2):118–27.

    Article  PubMed  Google Scholar 

  5. Giamberardino MA, Tana C, Costantini R. Pain thresholds in women with chronic pelvic pain. Curr Opin Obstet Gynecol. 2014;26(4):253–9. doi:10.1097/GCO.0000000000000083.

    Article  PubMed  Google Scholar 

  6. Tripp DA, Nickel JC, Wong J, Pontari M, Moldwin R, Mayer R, Carr LK, Doggweiler R, Yang CC, Mishra N, Nordling J. Mapping of pain phenotypes in female patients with bladder pain syndrome/interstitial cystitis and controls. Eur Urol. 2012;62(6):1188–94. doi:10.1016/j.eururo.2012.05.023.

    Article  PubMed  Google Scholar 

  7. Louw A, Diener I, Butler DS, Puentedura EJ. The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Arch Phys Med Rehabil. 2011;92(12):2041–56. doi:10.1016/j.apmr.2011.07.198.

    Article  PubMed  Google Scholar 

  8. Nijs J, Roussel N, Paul van Wilgen C, Köke A, Smeets R. Thinking beyond muscles and joints: therapists’ and patients’ attitudes and beliefs regarding chronic musculoskeletal pain are key to applying effective treatment. Man Ther. 2013;18(2):96–102. doi:10.1016/j.math.2012.11.001.

    Article  PubMed  Google Scholar 

  9. Hilton S, Vandyken C. The puzzle of pelvic pain—a rehabilitation framework for balancing tissue dysfunction and central sensitization I: pain physiology and evaluation for the physical therapist. J Womens Health Phys Ther. 2011;35(3):103–13.

    Article  Google Scholar 

  10. Brown B. The gifts of imperfection: let go of who you think you’re supposed to be and embrace who you are. Centre City: Hazelden; 2010.

    Google Scholar 

  11. Davidson RJ. One of a kind: the neurobiology of individuality. Cerebrum. 2014;2014:8.

    PubMed Central  PubMed  Google Scholar 

  12. Mantel H. How much pain is too much pain? IASP Insight. July 2013.

    Google Scholar 

  13. International Association of the Study of Pain. Taxonomy. http://www.iasp-pain.org/Content/NavigationMenu/GeneralResourceLinks/PainDefinitions/default.htm. Accessed 28 Aug 2014.

  14. Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150(3699):971–9.

    Article  CAS  PubMed  Google Scholar 

  15. Butler DS, Moseley GL. Explain pain. Adelaide: Noigroup; 2013.

    Google Scholar 

  16. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. The Adverse Childhood Experiences (ACE) Study: relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. Am J Prev Med. 1998;14(4):245–58.

    Article  CAS  PubMed  Google Scholar 

  17. Ustinova EE, Fraser MO, Pezzone MA. Cross-talk and sensitization of bladder afferent nerves. Neurourol Urodyn. 2010;29(1):77–81. doi:10.1002/nau.20817.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Mann J, Shuster J, Moawad N. Attributes and barriers to care of pelvic pain in university women. J Minim Invasive Gynecol. 2013;20(6):811–8.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Neville CE, Fitzgerald CM, Mallinson T, Badillo S, Hynes C, Tu F. A preliminary report of musculoskeletal dysfunction in female chronic pelvic pain: a blinded study of examination findings. J Bodyw Mov Ther. 2012;16:50–6.

    Article  PubMed  Google Scholar 

  20. Laekeman MA, Sitter H, Basler HD. The pain attitudes and beliefs scale for physiotherapists: psychometric properties of the German version. Clin Rehabil. 2008;22(6):564–75. doi:10.1177/0269215508087485.

    Article  Google Scholar 

  21. Foster NE, Thomas E, Bishop A, Dunn KM, Main CJ. Distinctiveness of psychological obstacles to recovery in low back pain patients in primary care. Pain. 2010;148(3):398–406. doi:10.1016/j.pain.2009.11.002.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Jordan JL, Holden MA, Mason EE, Foster NE. Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults. Cochrane Database Syst Rev. 2010;(1):CD005956. doi: 10.1002/14651858.CD005956.pub2.

  23. Miles CL, Pincus T, Carnes D, Homer KE, Taylor SJ, Bremner SA, Rahman A, Underwood M. Can we identify how programmes aimed at promoting self-management in musculoskeletal pain work and who benefits? A systematic review of sub-group analysis within RCTs. Eur J Pain. 2011;15(8):775.e1–11. doi:10.1016/j.ejpain.2011.01.016. Epub 2011 Feb 26.

    Google Scholar 

  24. Moseley GL. Reconceptualising pain according to modern pain science. Phys Ther Rev. 2007;12(3):169.

    Article  Google Scholar 

  25. George SZ, Teyhen DS, Wu SS, Wright AC, Dugan JL, Yang G, Robinson ME, Childs JD. Psychosocial education improves low back pain beliefs: results from a cluster randomized clinical trial (NCT00373009) in a primary prevention setting. Eur Spine J. 2009;18(7):1050–8. doi:10.1007/s00586-009-1016-7.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Smart KM, Blake C, Staines A, Doody C. Clinical indicators of ‘nociceptive’, ‘peripheral neuropathic’ and ‘central’ mechanisms of musculoskeletal pain. A Delphi survey of expert clinicians. Man Ther. 2010;15(1):80–7. doi:10.1016/j.math.2009.07.005.

    Article  PubMed  Google Scholar 

  27. Quartana PJ, et al. Pain catastrophizing: a critical review. Expert Rev Neurother. 2009;9(5):745–58.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Pinto P, McIntyre T, Almeida A, Araujo-Soares V. The mediating role of pain catastrophizing in the relationship between presurgical anxiety and acute postsurgical pain after hysterectomy. Pain. 2012;153(1):218–26.

    Article  PubMed  Google Scholar 

  29. Moseley GL, Butler DS, Beames TB, Giles TJ. The graded motor imagery handbook. Adelaide: Noigroup; 2012.

    Google Scholar 

  30. McCullough BJ, Johnson GR, Martin BI, Jarvik JG. Lumbar MR imaging and reporting epidemiology: do epidemiological data in reports affect clinical management? Radiology. 2012;262(3):941–6.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Butler D. The sensitive nervous system. Adelaide: Noigroup; 2000.

    Google Scholar 

  32. Bingel U, Tracey I. Imaging CNS modulation of pain in humans. Physiology. 2008;23:371–80.

    Article  PubMed  Google Scholar 

  33. Nijs J, Van Houdenhove B, Oostendorp RA. Recognition of central sensitization in patients with musculoskeletal pain: application of pain neurophysiology in manual therapy practice. Man Ther. 2010;15(2):135–41.

    Article  PubMed  Google Scholar 

  34. Nijs J, Paul van Wilgen C, Van Oosterwijck J, van Ittersum M, Meeus M. How to explain central sensitization to patients with “unexplained” chronic musculoskeletal pain: practice guidelines. Man Ther. 2011;16(5):413–8.

    Article  PubMed  Google Scholar 

  35. Ge HY, Fernandez-de-Las-Penas C, Yue SW. Myofascial trigger points: spontaneous electrical activity and its consequences for pain induction and propagation. Chin Med. 2011;6:13.

    Article  PubMed Central  PubMed  Google Scholar 

  36. FitzGerald MP, Payne CK, Lukacz ES, Yang CC, Peters KM, Chai TC, Nickel JC, Hanno PM, Kreder KJ, Burks DA, Mayer R, Kotarinos R, Fortman C, Allen TM, Fraser L, Mason-Cover M, Furey C, Odabachian L, Sanfield A, Chu J, Huestis K, Tata GE, Dugan N, Sheth H, Bewyer K, Anaeme A, Newton K, Featherstone W, Halle-Podell R, Cen L, Landis JR, Propert KJ, Foster Jr HE, Kusek JW, Nyberg LM, Interstitial Cystitis Collaborative Research Network. Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome and pelvic floor tenderness. J Urol. 2012;187(6):2113–8. doi:10.1016/j.juro.2012.01.123.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  37. Busch V, Magerl W, Kern U, Haas J, Hajak G, Eichhammer P. The effect of deep and slow breathing on pain perception, autonomic activity, and mood processing—an experimental study [published online ahead of print September 21, 2011]. Pain Med. 2012. doi:10.1111/j.1526-4637.2011.01243.x.

    Google Scholar 

  38. Schmidt S, Grossman P, Schwarzer B, Jena S, Naumann J, Walach H. Treating fibromyalgia with mindfulness-based stress reduction: results from a 3-armed randomized controlled trial. Pain. 2011;152(2):361–9.

    Article  PubMed  Google Scholar 

  39. Anderson RU, Wise D, Sawyer T, Glowe P, Orenberg EK. 6-day intensive treatment protocol for refractory chronic prostatitis/chronic pelvic pain syndrome using myofascial release and paradoxical relaxation training. J Urol. 2011;185(4):1294–9.

    Article  PubMed  Google Scholar 

  40. Apostolo J, Kolcaba K. The effects of guided imagery on comfort, depression, anxiety and stress of psychiatric inpatients with depressive disorders. Arch Psychiatr Nurs. 2009;23(6):401–11.

    Article  Google Scholar 

  41. Jordan JL, Holden MA, Mason EE, Foster NE. Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults. Cochrane Database Syst Rev. 2010;(1):CD005956.

    Google Scholar 

  42. Carrico DJ, Peters KM, Diokno AC. Guided imagery for women with interstitial cystitis: results of a prospective, randomized controlled pilot study. J Altern Complement Med. 2008;14(1):53–60.

    Article  PubMed  Google Scholar 

  43. Wren A. Yoga for persistent pain: new findings and directions for an ancient practice. Pain. 2011;152:477–80.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Catalano M. The chronic pain control workbook. 2nd ed. New York: New Harbinger; 1996.

    Google Scholar 

  45. Moseley GL, Zalucki N, Birklein F, Marinus J, van Hilten JJ, Luomajoki H. Thinking about movement hurts: the effect of motor imagery on pain and swelling in people with chronic arm pain. Arthritis Rheum. 2008;59(5):623–31.

    Article  PubMed  Google Scholar 

  46. Orlick T. In pursuit of excellence. Champaign: Human Kinetics; 2000.

    Google Scholar 

  47. Leknes S, Tracey I. A common neurobiology for pain and pleasure. Nat Rev Neurosci. 2008;9(4):314–20.

    Article  CAS  PubMed  Google Scholar 

  48. Kelly GA, Blake C, Power CK, O’keeffe D, Fullen BM. The association between chronic low back pain and sleep: a systematic review. Clin J Pain. 2011;27(2):169–81.

    Article  PubMed  Google Scholar 

  49. Reid KJ, Baron KG, Lu B, Naylor E, Wolfe L, Zee PC. Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia. Sleep Med. 2010;11(9):934–40.

    Article  PubMed Central  PubMed  Google Scholar 

  50. Thacker MA, Moseley GL. First-person neuroscience and the understanding of pain. Might science need philosophy for a precise and complete understanding of pain? Med J Aust. 2012;196(6):410–1.

    Article  PubMed  Google Scholar 

  51. Pearson N. Pelvic Health Solutions 2nd annual symposium, Vol. 1, 18 Jan 2014. Pain Science Education; 2014.

    Google Scholar 

  52. Pearson N. Understand pain, live well again. Penticton: Life Is Now; 2007.

    Google Scholar 

  53. Louw A, Hilton S, Vandyken C. Why pelvic pain hurts: neuroscience education for patients with pelvic pain. Minneapolis: OPTP; 2014.

    Google Scholar 

  54. Lumley MA, Cohen JL, Borszcz GS, Cano A, Radcliffe AM, Porter LS, Schubiner H, Keefe FJ. Pain and emotion: a biopsychosocial review of recent research. J Clin Psychol. 2011;67(9):942–68. doi:10.1002/jclp.20816.

    Article  PubMed Central  PubMed  Google Scholar 

  55. Hilton S, Vandyken C. The puzzle of pelvic pain—a rehabilitation framework for balancing tissue dysfunction and central sensitization, part II: a review of treatment considerations. J Womens Health Phys Ther. 2012;36(1):44–54. doi:10.1097/JWH.0b013e31824e0ab4.

    Article  Google Scholar 

  56. Eliasson K, Elfving B, Nordgren B, Mattson E. Urinary incontinence in women with low back pain. Man Ther. 2008;13:206–12.

    Article  PubMed  Google Scholar 

  57. www.guidedtherapeuticexercise.com

  58. www.healthy.kaiserpermanente.org/health/care

  59. O’Sullivan PB, Beales DJ. Diagnosis and classification of pelvic pain disorders-part 1: a mechanism based approach within a biopsychosocial framework. Man Ther. 2007;12:86–97.

    Article  PubMed  Google Scholar 

  60. Gutke A, Kjellby-Wendt G, Oberg B. The inter-rater reliability of a standardised classification system for pregnancy-related lumbopelvic pain. Man Ther. 2010;15:13–8.

    Article  PubMed  Google Scholar 

  61. Levitt M. Post-partum haemorrhoids-evaluation of a cooling device (Anurex) for relief of symptoms. Med J Aust. 1994;160(2):95.

    CAS  PubMed  Google Scholar 

  62. Franklin E. Pelvic power: mind/body exercises for strength, flexibility, posture and balance. Hightstown: Elysian Editions/Princeton Book Company; 2003.

    Google Scholar 

  63. Rost C. Relieving pelvic pain during and after pregnancy: How women can heal chronic pelvic instability. Almedas: Hunter House; 2007.

    Google Scholar 

  64. van der Velde J, Everaerd W. The relationship between involuntary pelvic floor muscle activity, muscle awareness and experienced threat in women with and without vaginismus. Behav Res Ther. 2001;39(4):395–408.

    Article  PubMed  Google Scholar 

  65. Woolf CJ. Review. Central sensitisation: implications for the diagnosis and treatment of pain. Pain. 2011;152:S2–15.

    Article  PubMed Central  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. The Center for Pelvic Health, 167 Hespeler Road, Cambridge, ON, N3C 3J1, Canada

    Carolyn Vandyken B.H.Sc. (P.T.)

  2. Entropy Physiotherapy and Wellness, 1925 N. Clybourn Ave, Suite 302, Chicago, IL, USA

    Sandra Hilton P.T., D.P.T., M.S.

Authors
  1. Carolyn Vandyken B.H.Sc. (P.T.)
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  2. Sandra Hilton P.T., D.P.T., M.S.
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Corresponding author

Correspondence to Carolyn Vandyken B.H.Sc. (P.T.) .

Editor information

Editors and Affiliations

  1. Urogynecology and Pelvic Floor Service, Assaf Harofeh Medical Center, Zerifin, Israel

    Anna Padoa

  2. Inner Stability, Ltd, Beit Shemesh, Israel

    Talli Y. Rosenbaum

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Vandyken, C., Hilton, S. (2016). A Tale of Two Pain States: The Integrative Physical Therapy Approach to the Overactive Pelvic Floor. In: Padoa, A., Rosenbaum, T. (eds) The Overactive Pelvic Floor. Springer, Cham. https://doi.org/10.1007/978-3-319-22150-2_18

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  • DOI: https://doi.org/10.1007/978-3-319-22150-2_18

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-22149-6

  • Online ISBN: 978-3-319-22150-2

  • eBook Packages: MedicineMedicine (R0)

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