Anxiety as the gasoline fueling the fire of pelvic pain
In
the conventional understanding and research over the past 50 years
that informs the medical treatment of pelvic pain syndromes, the
central role of anxiety in the perpetuation of pelvic pain has
been missed. The old and new medical models of these disorders
simply do not consider that anxiety has any role in the generation
of dysfunction or pathology within the pelvic floor. In fact,
as we demonstrate in the video clips below, and as we describe
in our book A Headache in the Pelvis, anxiety plays a huge role
in the generation of prostatitis and chronic pelvic pain disorders.
Many
of the people who have called us in the last several months have
reported that their pain and dysfunction substantially decreased
after simply reading our book. These patients told us that our
description of prostatitis and pelvic pain syndromes marked the
first time that they felt that someone understood what was going
on with them and offered an intuitively viable solution. Yet how
could simply reading a book lower the level of pain and dysfunction
that these people had?
Furthermore,
when the doctors that you see for pelvic pain and dysfunction
have no solutions for you and foresee no solutions, the psychological
consequences are very deep and very painful.
Most
clinicians rarely have the time or inclination to delve into the
kinds of thinking that is common to people with pelvic pain. Typically,
the person with prostatitis or other chronic pelvic pain syndromes
lives in a dark world of negative thought. As we have discussed,
in chapter three and four, each negative thought is taken to be
real by the body as it contracts against the scary world created
by the thought. These scary thoughts are like gasoline on the
fire of the pelvic pain as they increase the electrical activity
in the active painful trigger points and areas of chronic restriction
within the pelvic floor. This increased pain leads to a reflexive
and protective tightening of the muscles against the pain which
then sets off a storm of more negative thinking. This cycle is
cruel, self perpetuating, and takes on a life of its own.
The
loneliness of having chronic pelvic pain has a number of sources.
The seemingly insolvable and apparently real negative thinking
that the sufferer lives in is one source. Another source, rarely
discussed, is that no one seems to want to hear what the person
with pelvic pain is thinking. The reason for this is that the
person who hears these thoughts usually feels helpless around
them. This is particularly true of doctors whom patients visit
for treatment. The doctor is used to being able to solve the patient's
problem. In the case of prostatitis and chronic pain syndromes,
the doctor is left feeling helpless and ineffectual. It is no
wonder that patients report their sense that doctors seem to rush
through their visits giving the appearance of wanting to spend
as little time with them as possible.
Our
approach is very much interested in all of these dark and negative
thoughts. Why? Each negative thought perpetuates the distress
of the sufferer and is rarely true when subjected to thoughtful
inquiry. The method that we share in chapter four, deriving from
the work of Byron Katie and Frederick Perls, aims to take the
sting out of these thoughts by exposing them to the light of inquiry
regarding their validity. Our approach to dealing with the cognitive
exacerbation of pelvic pain involves facing the demons of the
scary and negative catastrophic thoughts. We do this by bringing
the executive function of discrimination and evaluation to bear
on the primitive early conditioning that usually gives rise to
these thoughts. The methodology that we have developed is brief,
direct and effective. Furthermore, we teach the patient to use
this method on a daily basis at home.
We
have found that in large part, the negative thinking of pelvic
pain sufferers functions to defend them against the disappointment
of getting their hopes up, only to find them dashed. Disappointment
as a human suffering is not often discussed in the treatment of
anxiety and depression related to pelvic pain. I have found aversion
to disappointment to be one of the primary sources of contraction
and catastrophic thinking. In the 5th edition of our book,
we include the questions we use to help neutralize the frequency
and impact of the negative thinking so endemic to and exacerbating
of the conditions we discuss here. |
