Recently, there has been an explosion of research into endometriosis associated pain and the influence of central mechanisms in the pain experience. Endometriosis-associated pain syndrome (EAP) is defined as “chronic or recurrent pelvic pain in patients with laparoscopically confirmed endometriosis”, and the term is used when the symptoms persist despite adequate endometriosis treatment.1

Tracey was referred to Pelvic Health Matters with dyspareunia, vulvodynia, and pelvic floor muscle dysfunction following gynaecological surgery.  This case study explores the impact of psychological and social factors on Tracey’s pain experience. It highlights the importance of following a biopsychosocial approach incorporating therapeutic neuroscience concepts when developing an effective treatment program.

The research is now undeniable - educating a patient about the science of pain is an essential component of persistent pain care.  Unfortunately, pain education is not easy and finding the right language is challenging for many health professionals.

According to the 2022 European Association of Urology Guidelines on Chronic Pelvic Pain, Persistent Pelvic Pain (PPP) is persistent pain perceived in structures related to the pelvis of either men or women1.  PPP can be further categorised as Chronic Primary Pelvic Pain, where there is no obvious pathology and Chronic Secondary Pelvic Pain, where there is specific disease or pathology associated pelvic pain1.  For both categories, pain must have been continuous or recurrent for at least 3 months or have been in a cyclical pattern for at least 6 months.

Vulvodynia is a chronic vulvar pain condition affecting 8-16% of women at some point in their lives1. It is the most common cause of sexual pain in pre-menopausal women.1 Despite the high prevalence and significant impact on quality of life, it remains poorly understood and often mis-diagnosed and mis-managed. With advances in pain neuroscience and central pain mechanism research over recent years, our understanding of vulvodynia has moved from a focus on local nociception to viewing it as a complex pain presentation. This demands a neurobiological and biopsychosocial approach to assessment and management1.