All of the pelvic pain patients I have treated since 2010 fall somewhere on this scale. Where do you fall?
There is no such thing as a ‘typical’ pelvic pain or CPPS/CP patient. That is unfair to those patients that suffer with these symptoms. Each case is unique and individual to the patient. It is becoming clear however that there are certain patterns that befall CPPS/CP patients. I have seen 100’s of patients over the past 9 years that I have helped in their recovery from CPPS/CP. The below is a guide to the types of pelvic pain patients I see. These are commonalities if you like in the patients coping and management strategies. It is often these coping strategies that drive my decisions in their individually tailored recovery program
The scale of pelvic pain patients I see
At one end of the scale I have patients who hammer on with their lives regardless of their symptoms. These could be described as ‘Endurerers’. At the other end I have those who cease or stop multiple key aspects of their lives. I term this patient population ‘Avoiders’. We could also look at this in terms of how humans ‘classically’ respond to threat and danger. The Endurers go into ‘fight’ mode and the Avoiders go into ‘freeze’ mode. Symptoms of pelvic pain can most definitely be perceived as threatening or dangerous to the sufferer
Typically I see these behaviours across a range of key activities or lifestyle choices. These categories often overlap and intertwine with the others e.g. drinking, socialising and food for example:
- Work
- Exercise
- Socialising
- Food
- Drink
- Sex
‘Endurers’ will classically carry on regardless of the effect their lifestyle has on their symptoms. To begin with these patients may not even be aware of the impact they are having on their symptoms. At the other end of the scale the ‘Avoiders’ can become very fearful of the effect of almost every aspect of their life on their symptoms. Conversely this approach may also be having a negative impact on the patients symptoms. Getting the balance right is key to recovery.
I should also note at this stage that I might have ‘Endurers’ who avoid sex or masturbation, for example, but carry on regardless in all other aspects of their life. Or I might see ‘Avoiders’ who flog themselves at work but have ceased virtually every other aspect of their lives. The 2 ends of the scale are interchangeable within those 6 aforementioned categories within each individual
Treating patients using the scale of pelvic pain
For the ‘Avoiders’ I encourage and guide graded exposue to meaningful activity. The objective being to keep activity levels below the pain radar or, managing their frequency to allow the body to de-sensitise after the activity e.g. sex or masturbation. The aim here is to ‘build their systems back up’ and increase:
- Robustness
- Self efficacy
- Confidence
- Trust in the patients body once more
- Boundaries for meaningful activities
For the ‘Endurers’ I teach them to ‘calm their systems down’ using the principles of allostatic load (here and here) – soothing, softening, easing and allowing the body to rest and recover. Promoting parasympathetic activity and ‘working in’ (as opposed to ‘working out’). The aims here are very similar to those of the ‘Avoiders’ – promoting:
- Self efficacy
- Confidence
- Trust in the patients body once more
- Boundaries for meaningful activities
The recovery plans I devise for either cohort of patient will heavily involve the 5 principles of dosage:
- Duration
- Intensity
- Frequency
- Rest
- Timing
At each follow up session I assess and progress the patients recovery program. The patient identifies new meaningful goals and targets and I use the principles of dosage to make these achievable
Thoughts on the pelvic pain scale
I am not saying the model is perfect by any means but it provides a sound and recognisable framework for patients and other health care providers to consider when planning an individuals recovery. These concepts are not new and have been around for a while when describing other persistent pain patients. I am applying them and updating them for male pelvic pain
Of course, each patient is different and unique in their personality and approach when initially recovering from pelvic pain. I use a fine balance to ensure I get the best results for each patient. Identifying meaningful activity and movement and setting achievable goals and targets. This is best achieved through a strong therapeutic alliance (here and here)
To find out more about my approach to the recovery from pelvic pain please follow this link