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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

Boundaries, Self-Care, and Meditation - Remote Course

Sep 12, 2020 - Oct 11, 2020
Location: Replacement Remote Course

Mobilization of Visceral Fascia: The Urinary System - Phoenix, AZ (Postponed)

Oct 2, 2020 - Oct 4, 2020
Location: Banner Physical Therapy and Rehabilitation

Mobilization of Visceral Fascia: The Urinary System - Medford, OR Satellite Location

Oct 2, 2020 - Oct 4, 2020
Location: Asante Rogue Valley Medical Center

Mobilization of Visceral Fascia: The Urinary System - Self-Hosted

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Mobilization of Visceral Fascia: The Urinary System - San Diego, CA Satellite Location

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Location: FunctionSmart Physical Therapy

Mobilization of Visceral Fascia: The Urinary System - Colorado Springs, CO Satellite Location

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Location: Manual Edge Physiotherapy

Mobilization of Visceral Fascia: The Urinary System - Fairlawn, NJ Satellite Location

Oct 2, 2020 - Oct 4, 2020
Location: Bella Physical Therapy

Low Pressure Fitness for Pelvic Floor Care - Trenton, NJ (Postponed)

Oct 2, 2020 - Oct 4, 2020
Location: Robert Wood Johnson Medical Associates

Pelvic Floor Level 1 - Grandville, MI Satellite Location

Oct 3, 2020 - Oct 4, 2020
Location: Apogee Therapy Center

Pelvic Floor Level 1 - Ann Arbor, MI Satellite Location

Oct 3, 2020 - Oct 4, 2020
Location: Probility Physical Therapy

Pelvic Floor Level 1 - Lansing, MI (Postponed)

Oct 3, 2020 - Oct 4, 2020
Location: Physical Therapy Services of Lansing

Pelvic Floor Level 1- Canton, OH (POSTPONED)

Oct 3, 2020 - Oct 4, 2020
Location: Aultman Hospital

Pudendal Neuralgia and Nerve Entrapment - Minneapolis, MN (Postponed)

Oct 3, 2020 - Oct 4, 2020
Location: Viverant

Yoga for Pelvic Pain - Remote Course

Oct 3, 2020 - Oct 4, 2020
Location: Replacement Remote Course

Male Pelvic Floor - Colorado Springs, CO

Oct 3, 2020 - Oct 4, 2020
Location: St. Francis Medical Center

Oncology of the Pelvic Floor Level 2A - Chicago, IL (Postponed)

Oct 3, 2020 - Oct 4, 2020
Location: Advocate Illinois Masonic Medical Center

Yoga for Pelvic Pain - Albany, NY (Postponed)

Oct 3, 2020 - Oct 4, 2020
Location: The Sage Colleges

Pelvic Floor Level 1 - Satellite Lab Course

Oct 3, 2020 - Oct 4, 2020
Location: Replacement Remote Course

Pelvic Floor Level 1 - Self-Hosted

Oct 3, 2020 - Oct 4, 2020
Location: Self-Hosted Course

Pelvic Floor Level 1 - Canton, OH Satellite Location (SOLD OUT)

Oct 3, 2020 - Oct 4, 2020
Location: Aultman Hospital

Boundaries, Self-Care, and Meditation - Princeton, NJ

Oct 9, 2020 - Oct 11, 2020
Location: Princeton Healthcare System

Pelvic Floor Level 2A - Self-Hosted

Oct 10, 2020 - Oct 11, 2020
Location: Self-Hosted Course

Pelvic Floor Level 1 - Boston, MA (Postponed)

Oct 10, 2020 - Oct 11, 2020
Location: Northeastern University

Pelvic Floor Level 1 - San Diego, CA Satellite Location

Oct 10, 2020 - Oct 11, 2020
Location: Water and Sports Physical Therapy Clinics

Pelvic Floor Level 2A - Kansas City, MO (Postponed)

Oct 10, 2020 - Oct 11, 2020
Location: Centerpoint Medical Center

Pelvic Floor Level 1 - Appleton, WI Satellite Location

Oct 10, 2020 - Oct 11, 2020
Location: Orthopedic & Spine Therapy

Pelvic Floor Level 1 - San Diego, CA (Postponed)

Oct 10, 2020 - Oct 11, 2020
Location: Water and Sports Physical Therapy Clinics

Osteoporosis Management - Remote Course (Rescheduled)

Oct 10, 2020 - Oct 11, 2020
Location: Replacement Remote Course

Pregnancy Rehabilitation - Remote Course

Oct 10, 2020 - Oct 11, 2020
Location: Replacement Remote Course