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Herman & Wallace Blog

Neurobiology of Pain

A systematic review from July of 2013 addressed how interpersonal factors modulate pain. Four primary findings of the research that are found to affect pain-related responses are as follows: the degree to which social partners were active (or perceived to be able to be active), the degree to which participants could perceive the specific intentions of the social partners, the pre-existing relationship between the subject and the social partner, and individual differences in relating to others (including coping styles).

Some patients are negatively impacted by a partner who is attentive to pain, with increased reports of pain, worse pain outcomes when together versus alone, and with longer lasting pain states. On the other hand, some patients respond favorably to a partner's support, with lower reports of pain states when offered support such as holding the hand of a partner. Because each person's relationship and response to the pain within the context of the relationship varies, the impact of a partner on perceived pain is also varied. The authors, after describing details and evidence of pain modulation research, conclude the following: "Specifically, interpersonal exchanges affect precision or salience by socially signaling the safety or threat of the impending stimulus itself or the environment in which the stimulus occurs."

How can we take this information to heart within the pelvic rehabilitation practice? One of the ways that we offer support to a couple is by inviting a partner to attend a clinic session where he or she can learn to assist in application of soft tissue release techniques. The partner has the opportunity to be validated in both the gratitude that the therapist offers to the patient and partner for attending, and also in the fact that pelvic pain is commonly encountered. Because pelvic pain can interfere with a couple's intimacy, having such validation about the physicality of pain, when present, may be useful in a relationship. When a partner learns how to be of help in the healing process, this may also affect the factors mentioned in the cited research article, specifically, how partners are perceived to be able to be active or perception of specific intention.

It has been my clinical experience that partners are very specific in intention once being trained in how to help with pelvic pain, and that intention is to be a part of the healing process. It has also been an observation that if a partnership is struggling with their relationship, that issues can surface once asked to engage in pelvic muscle rehabilitation. This might mean that a patient chooses to pause rehabilitation and enter psychological counseling or other healing work. It also might mean that the patient chooses to not request help of the partner in the clinic or at home for the time being.

In relation to the pre-existing interpersonal factors, we do not necessarily know the extent to which the patient, partner, or the relationship has the ability to cope with challenges, or what type of relationship is in place. For that reason, we must remain nonjudgmental, and recognize that as rehabilitation professionals, we are limited by the scope of our practice and may serve the patient best by coordinating a referral to a counselor or psychologist. If you are interested in learning more about the research as well as the practical clinical implications of pain neurobiology, we still have a few seats left in our continuing education course titled Meditation and Pain Neuroscience. This course takes place in September in Illinois, and features an accomplished physical therapist as well as a psychiatrist. This course will offer an amazing learning experience as it combines the perspectives of medicine and rehabilitation, we hope you can join us!

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Upcoming Continuing Education Courses

Pregnancy Rehabilitation - Seattle, WA (SOLD OUT)

Feb 22, 2020 - Feb 23, 2020
Location: Pacific Medical Centers

Manual Therapy Techniques for the Pelvic Rehab Therapist - Pasadena, CA

Feb 22, 2020 - Feb 23, 2020
Location: Huntington Hospital

Pelvic Floor Level 2B - Alexandria, VA (SOLD OUT)

Feb 28, 2020 - Mar 1, 2020
Location: Inova Physical Therapy Center

Pelvic Floor Level 2B - Fort Worth, TX (SOLD OUT)

Feb 28, 2020 - Mar 1, 2020
Location: University of North Texas Health Science Center

Pediatric Functional Gastrointestinal Disorders - Charlotte, NC

Feb 28, 2020 - Mar 1, 2020
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Rehabilitative Ultrasound Imaging: Orthopedic Topics - Raleigh, NC

Feb 28, 2020 - Feb 29, 2020
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Pelvic Floor Series Capstone - Phoenix, AZ (SOLD OUT)

Mar 6, 2020 - Mar 8, 2020
Location: 360 Sports Medicine & Aquatic Rehabilitation Centers

Pelvic Floor Level 1 - Salida, CO (SOLD OUT)

Mar 6, 2020 - Mar 8, 2020
Location: Heart of the Rockies Regional Medical Center

Pelvic Floor Level 1 - Columbia, MO

Mar 6, 2020 - Mar 8, 2020
Location: University of Missouri-Smiley Lane Therapy Services

Pelvic Floor Level 1 - Princeton, NJ (SOLD OUT)

Mar 6, 2020 - Mar 8, 2020
Location: Princeton Healthcare System

Pelvic Floor Level 1 - New Orleans, LA (SOLD OUT)

Mar 6, 2020 - Mar 8, 2020
Location: Ochsner Health System

Mobilization of the Myofascial layer: Pelvis and Lower Extremity- Grand Rapids, MI

Mar 6, 2020 - Mar 8, 2020
Location: Spectrum Health System

Bowel Pathology and Function -Salt Lake City, UT

Mar 7, 2020 - Mar 8, 2020
Location: Veterans Administration - Salt Lake City

Postpartum Rehabilitation - Washington, DC (SOLD OUT)

Mar 7, 2020 - Mar 8, 2020
Location: GWUH Outpatient Rehabilitation Center

Pelvic Floor Level 1 - Virginia Beach, VA (SOLD OUT)

Mar 13, 2020 - Mar 15, 2020
Location: Sentara Therapy Center - Princess Anne

Pelvic Floor Level 2A - Philadelphia, PA (SOLD OUT)

Mar 13, 2020 - Mar 15, 2020
Location: Thomas Jefferson University

Pelvic Floor Level 1 - Manchester, NH (SOLD OUT)

Mar 13, 2020 - Mar 15, 2020
Location: Franklin Pierce University

Meeks Method for Osteoporosis - Minneapolis, MN

Mar 14, 2020 - Mar 15, 2020
Location: Park Nicollet Clinic--St. Louis Park

Pelvic Floor Level 2A - Minneapolis, MN (SOLD OUT)

Mar 20, 2020 - Mar 22, 2020
Location: Allina Hospitals and Clinics

Nutrition Perspectives for the Pelvic Rehab Therapist - San Diego, CA

Mar 20, 2020 - Mar 22, 2020
Location: Comprehensive Therapy Services

Pelvic Floor Level 1 - Birmingham, AL

Mar 20, 2020 - Mar 22, 2020
Location: Shelby Baptist Medical Center

Mobilization of Visceral Fascia: The Urinary System - Carlsbad, CA

Mar 20, 2020 - Mar 22, 2020
Location: Tri-City Medical Center

Pelvic Floor Level 1 - Bellingham, WA (SOLD OUT)

Mar 20, 2020 - Mar 22, 2020
Location: PeaceHealth- St. Joseph Medical Center

Pelvic Floor Level 1 - Los Angeles, CA (SOLD OUT)

Mar 20, 2020 - Mar 22, 2020
Location: Mount Saint Mary’s University

Breastfeeding Conditions - Phoenix, AZ

Mar 21, 2020 - Mar 22, 2020
Location: Banner Physical Therapy and Rehabilitation

Breathing and the Diaphragm: Orthopedic Therapists - Sterling Heights, MI

Mar 27, 2020 - Mar 29, 2020
Location: Henry Ford Macomb Hospital

Breathing and the Diaphragm: Pelvic and Orthopedic Therapists - Sterling Heights, MI

Mar 27, 2020 - Mar 29, 2020
Location: Henry Ford Macomb Hospital

Pelvic Floor Level 1 - Corvallis, OR

Mar 27, 2020 - Mar 29, 2020
Location: Albany Sport & Spine Physical Therapy

Breast Cancer Rehabilitation - Alexandria, VA

Mar 28, 2020 - Mar 29, 2020
Location: Inova Physical Therapy Center