The Science of Pain – How to Explain It, Use It, and Transform Your Pelvic Health Sessions

• Learn more about Level 1 Functional Pelvic Health Practitioner program
• Get certified in pelvic health from the OT lens here
• Grab your free AOTA approved Pelvic Health CEU course here.

Here is the link to the worksheet called Pain Recipe Handout

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Transcript

Hey, everybody, welcome back to the OTs in pelvic health podcast. If you've ever felt stuck trying to explain to a client, why their pelvic pain is so real get their scans look normal, or they've been dismissed by other providers. This episode is going to change how you practice in today's episode.

I'm breaking down the game changing science from pain. Psychologist doctor's office on how pain is actually made in the brain. Not just the body part that hurts, you'll learn the simple smoke alarm metaphor, the powerful pain recipe framework and 3 real pelvic health case studies with exact language that you can use tomorrow.

This is practical trauma informed and immediately usable. I can't wait for you to hear today's episode.

  
Intro 

Okay, if you see clients with interstitial cystitis, dyspareunia, endometriosis, postpartum pelvic pain, or any of the complex chronic pain presentations that can leave us scratching our head.

Sometimes this episode is for you. We already teach that pain is not just a tight pelvic floor problem, right? We know this innately as. But today we're going to unpack the real neuroscience of pain, why it's made in the brain, not just the body part that hurts and exactly how you can explain this to clients in plain validating language.

I'm also going to walk you through the pain recipe concept that doctor's office uses, share 3 detailed pelvic health case studies with exact scripts you can adapt and give you some really concrete ways to weave this into your existing toolbook. We're going to talk about 1 to 2 breathing, window of tolerance, tracking, graded exposure, hierarchies, safe space, language, and more. Now, this work that we're talking about today is also based on the level 2 trauma informed pelvic health certification.

So if you're geeking out on what we're talking about today, we would love to support you in the next cohort. Details are in the show notes. Okay, grab your notebook, maybe a cup of tea, and let's get into it.

I'm going to start with the foundational truth that shifts everything. Here it is. Pain is constructed in the brain.

Your brain is the ultimate danger detector. It collects nociceptive signals from your tissues, but it also pulls in emotions, memories, stress levels, social context, predictions, and past experiences before deciding whether to produce pain and at what volume. This is literally why phantom limb pain exists, right? People feel terrible pain in a leg or a hand that is no longer there because the brain map hasn't updated yet.

So Dr. Zoffner shared two unforgettable construction worker stories that I now use with almost every pelvic pain client. First up, a worker jumps off a plank and lands directly on a 7-inch nail. He has terrible pain.

He's rushed to the ER, given opioids and fentanyl. When they remove his boot, it is nothing short of a miracle. The nail slid perfectly between his toes.

I'm not joking. Like, you cannot make this stuff up. No puncture, no blood, no tissue damage, but his pain was 100% real.

His brain saw the nail, heard his co-workers gasp, remembered other job site injuries, and screened danger. So it made intense pain to protect him. 

The second story was another construction worker.

Clearly, this is the most dangerous, the most dangerous occupation there is, gets hit in a jaw by a ricocheting nail gun. He has mild toothache for about six days. He finally ends up dragging himself to the dentist and they discover a 4-inch nail embedded through his jaw and into his frontal lobe.

He had real structural damage, yet almost no pain. Same brain, completely different context. What I take away from this is pain is not a direct read-out of damage.

And this is actually why scans can mislead us and our clients. Landmark studies scanned thousands of people with zero back pain and found that 80 to 90% of adults over 50 have bulging discs, disc degeneration, and other abnormalities. Yet when a client in pain gets the same scan, they're often told, oh, that's the cause, right? We found it.

This is correlation, not causation. Did you know that Usain Bolt, widely regarded as the greatest sprinter of all time, right, first man to hold both 100 meter and 200 meter world records of 9.58 seconds? And 19.9 seconds respectively, right? He's won eight Olympic gold medals, 11 world championship titles. I could go on and on.

Did you know that he also has severe scoliosis? Literally one leg is half an inch shorter than the other, and he still holds these world records. His spine looks like a bowl of spaghetti on imaging. Yet he runs like lightning.

Damage and pain are not the same thing. And in fact, they discovered that his scoliosis could be the very thing, the very reason he's capable of achieving all of these records. 

In pelvic health, we see this every day.

Clients with quote unquote normal imaging who are in terrible pain and others with significant findings who function well once their nervous system feels safe. So how do we explain this to clients without sounding like we're dismissing their very real pain? 

So I will often incorporate the smoke alarm metaphor, right? I'll say something like this and like, please adopt it and make it your own. 

Pain is your brain's alarm system.

It's designed to protect you. Sometimes the alarm goes off because there's a real fire, right? Actual tissue threat. Sometimes the alarm has become extra sensitive after months or years of pain, stress or feeling unsafe.

The pain is a hundred percent real either way. Our job together is to turn the volume down on that overly sensitive alarm so that you can get back to the life you want. My clients light up when they hear this.

It's validating, non-blaming and immediately opens the door to hope and agency. 

OK, let's talk now about the pain recipe. This is the framework I hand every client.

And I think it's just tangible and usable, it breaks down biopsychosocial in a really streamlined way. 

OK, so I say something like every person's pain is made from three categories of ingredients that interact all the time. 

Number one, biological.

This is tissue health, pelvic floor guarding, sleep, movement, hydration, nutrition and hormones. Second up, psychological. 

Thoughts, emotions, attention, fear, stress, past trauma and a hyper focus on sensations. 

Last up, social. This is feeling believed or dismissed, isolation versus connection, partner dynamics, cultural messaging around pushing through pain.

When any ingredient increases danger signals, the brain responds by turning the pain volume up. When we lower danger and increase safety across these domains, pain volume comes down. 

So I give clients this like one and a half page recipe handout. I'll link to it in the show notes and we map theirs together right in the session and it becomes our shared language moving forward. 

All right, let's make this concrete with three real world pelvic health case studies.

I change names and details, but these basically are stories of clients I've worked with and patterns that I see consistently. Please meet Sarah. She's 34.

She has interstitial cystitis and dyspnea. Sarah has been mostly housebound for nearly two years. She has had multiple urologists, medications and pelvic floor therapy focused only on down training.

And it hasn't helped. She was on a strict white food diet, right? Pasta, rice, spent days on the couch, basically avoided intimacy and felt hopeless. Her pain recipe for the biological was poor sleep, minimal movement, dehydration and nutrient poor diet.

For the psychological, it was catastrophic thoughts. Right. So she would think things like if I have sex, it will flare for days.

Right. She had a hyper focus on every bladder sensation and anticipatory anxiety. The social aspect, shame, isolation and partner disconnection.

So what did we do? Right. We started tiny, exactly the tools that you probably already know. 

Week one, we did one to two breathing in the car on the way home from work.

Week two, short walks to the mailbox while practicing grounding through points of contact. We added one colorful vegetable to one meal a day. And we scripted a low pressure conversation with her partner about pacing intimacy using our graded exposure.

Within six weeks, her flares decreased in intensity and frequency. She started leaving the house more and sleeping better. Most importantly, she said to me, I finally feel like I have a plan and I'm not alone.

That's ventral vagal safety showing up in real time. 

All right. Case study two, Maya.

She's 41 and she had postpartum deep dyspnea after a fairly traumatic birth. Maya had not really done well in traditional pelvic floor therapy because every attempt at internal work made her guard more. Her recipe was heavy on psychological and social ingredients.

So anticipatory fear, history of feeling dismissed by providers and belief that her body is broken. So with Maya, we used safe space language. So I always used explicit consent with her, which is something that I talk about in both level one and level two programs through the functional pelvis.

And I would say things like, would it be OK if we explore some options together? We started with external visualization and breath, progressed to self-touch with a mirror by using one to two breathing and then added the pelvic wand only after she felt in control. We tracked her window of tolerance each session and we celebrated every tiny step. About seven months later, she was able to have pain free intimacy with her partner for the first time in years.

Her words were, I stopped believing the pain meant I was broken. I started believing my body just needed to feel safe. I think she said that so beautifully.

The last case study I want to bring up to you is Elena, who's 29. She has vulvodynia and persistent genital arousal. Elena's pain was constant burning at the anchoitus.

I think she had seen close to six or seven providers and was told everything looks normal, Elena. Right. You've you've heard that before with your clients, I'm sure.

And it's probably one of the most frustrating things they can hear. Her recipe was dominated by psychological hypervigilance and social isolation. She stopped dating and avoided all touch.

So we mapped her recipe in session two. The biological piece was clenching her jaw and pelvic floor all day from anxiety. The psychological piece was constant scanning for symptoms and catastrophic thoughts.

And the social aspect was feeling like, quote unquote, no one believes me. So with Elena, we started with a sensory checklist to identify safe, soothing inputs. She loved weighted blankets.

She loved soft classical music and warm socks. We practiced reclaiming your skin's boundaries, which is a beautiful, reflective piece that I teach you in the level two trauma certification course. It's actually the guided practice that helped me significantly when my private practice was in New York City and I felt bombarded.

She loved this practice and did it daily. We also did graded exposure. Basically, we started with external work first, and then I think we ended up working towards a gloved finger.

Only after goodness, it was probably a couple of months because I was really wanting her to stay in that window of tolerance before progressing. We definitely added daily resilience routines, super short, super short. And we invited her partner to a couple sessions where he really got to understand what she was experiencing.

Within probably close to five or six months, her baseline burning dropped from seven out of ten to two out of ten. And she felt like the biggest shift was realizing she could actually influence her pain volume. So I hope those case studies helped you put some of this really into perspective and see how you could bring it into your own practice.

I have five more suggestions for you to really make this as practical as I can. Number one, tomorrow, explain pain with that smoke alarm metaphor and hand out the pain recipe sheet at the first or second visit. I'm going to link to the pain recipe sheet in the show notes.

Map the recipe, map the recipe collaboratively. Right. It becomes a living document that you revisit every, if not every session, every two or three sessions, because it'll also help both of you see how things are changing and just the progress that's being made, which really helps intrinsic motivation.

Number three, integrate your existing tools. Right. Whatever you're currently using that your clients love, bring it in.

This could be one to two breathing before any internal assessment or treatment or external. Right. If you've taken my courses, you know, I teach four menu options for the internal exam because I innately believe that the internal exam is not the gold standard.

Track the window of tolerance at the start of every session and try building graded exposure hierarchies that include psychological and social steps, not just physical ones. 

Number four, offer choice and invitational language at every step. This alone lowers the danger signal.

Last up, number five, address the social piece. Encourage clients to share one safe person about their pain. Encourage clients to share with one safe person about their pain or bring in a partner to a session if they would like that to be there.

This work is deeply trauma informed because it puts safety choice and collaboration at the center. It honors that pain is real and changeable. You already have so many of the tools.

I hope this framework just helps you explain why they work and gives your clients some concrete agency. Thank you for the powerful, compassionate work you do every single day. Your clients are so lucky to have an OT who understands that true healing happens when the whole nervous system feels safe.

I'll see you in the next episode. Until then, keep creating safety one nervous system at a time.