The Complexity of Pain with Dr Jessica Theron
In this guest post, the amazing Dr Jessica Theron, an Obstetrics & Gynaecology registrar and founder of Ella Health discusses the different facets of pain, and pain management strategies to help.
Pain is an unpleasant sensation that’s produced by our brain in response to actual or potential tissue damage. It’s a subjective experience in the sense that everyone’s sensation of pain is slightly different. The pain we feel is a combination of the input coming from our body from our nervous system (bottom-up signals) AND messages from primitive parts of our brain like the amygdala and limbic system (top-down signals).
There are different types of pain including nociceptive, neuropathic and neuroplastic pain (pain system hypersensitivity). Most of the time with chronic pelvic pain we’re dealing with nociceptive and neuroplastic pain.
Nociceptive pain is the acute pain we get from inflammation from an injury or infection. An example of nociceptive pain would be the cramping pain we feel in response to the physical release of prostaglandins that trigger our ovaries etc to do their thing each month.
Neuroplastic pain is a little more complex and refers to the changes in our nervous system that amplify the pain signals being sent to the brain. With neuroplastic pain, the ‘bottom-up signals’ become highly sensitive, and our brain starts to interpret the wrong signals as being painful.
Things that are not normally painful, like light touch, can start to feel painful. We can also start to experience other symptoms like muscle stiffness, fatigue, poor memory and concentration, headaches, restless legs, diarrhoea and/or constipation. We call this a ‘sensitised’ nervous system and studies have shown that almost 75% of people presenting with pelvic pain can have a sensitised nervous system.
Another important thing to talk about is nervous system dysregulation. This can happen when there’s an imbalance between the sympathetic and parasympathetic branches of the autonomic nervous system. The autonomic nervous system controls involuntary actions such as breathing and heart rate. The sympathetic nervous system is known for its ‘fight or flight’ response when we’re faced with stress… but it also plays an important role in lots of other helpful things like concentration, physical endurance and strength. The parasympathetic nervous system, also known as ‘rest and digest’, can be thought of as functioning in opposition to the sympathetic nervous system.
We can get into trouble when our sympathetic nervous system is chronically activated, from things like early trauma and chronic stress, because it then overtakes the parasympathetic nervous system. This keeps us on alert and prevents us from properly recovering from stressful experiences.
There are lots of things we can do things to help restore balance in the nervous system. One way we can do this by building up the parasympathetic branch of the nervous system, which controls those ‘rest and digest’ functions. A good way to do this is through breathing techniques and mindfulness. One of my favourite breathing techniques for people with chronic pelvic pain is deep belly breathing.
Other things that can worsen pain include fatigue, anxiety, depression, and being in a negative emotional state. We’ve done functional MRI scans on people experiencing emotional pain and seen that the same part of the brain lights up as when we experience physical pain. Seeing a psychologist can really help with these aspects of your condition.
Ella is an online platform and community making care for people with chronic pelvic pain more affordable and accessible. Ella offers things like daily mindfulness, meditation, relaxation and CBT audio sessions, as well as guided breathwork.
We’ve partnered with some amazing clinicians to put all this good stuff in one place. Our first product is a 6-week pain program delivered via our Ella app. It’s the first of its kind in Australasia and we’re pretty proud of it! Head on over to ellahealth.co if you want to join our waitlist 💛
Written by Dr. Jessica Theron.
Jess is an Obstetrics & Gynaecology registrar with NSW Health, and founder of Ella Health, the first-ever holistic digital platform designed specifically to address chronic pelvic pain.