This is a brief post about one aspect of addressing pudendal neuralgia (PN), often a very troubling and painful condition. I see this in men and women (see Sanjay’s story here). Here I tap into some of the key points, but merely scratching the surface of enormous topics.
As with many conditions that feature chronic pain, the main focus is typically upon the structure, an injury and the possible causes of the symptoms. This is the biomedical model, and it is only satisfied when something is found to be intervened upon.
Whilst it is important to rule out anything sinister and diagnose an injury or disease, this model does not offer the comprehensive way forward that people desire or need. Injections, medicines and passive treatments do not teach people how to get better. Getting better is an active process of choosing certain actions to allow our biology to work for us. Already you can start to understand the title of the blog.
A common phrase I use with patients is: ‘most of the biology of pain, and there’s nothing specific to pain, is not where you feel it’.
So what is that all about?
The brain is a predictor. This means the brain makes best it’s best guess about the causes of the sensory information coming in — think about the immense amount of data to infer the meaning of! We experience predictions, or best guesses, which are usually pretty good. On weighing up the evidence, if the brain concludes, and continues to conclude that pain is the best explanation for the incoming signals based on prior experience, the pain persists until other evidence can update the prediction. Now, we don’t want to become wholly brain focused as the brain needs a body, we experience ourselves with a body and certainly, pain is embodied.
The latter is really our job, helping the person to update their model of the world and infer something different by ‘creating’ credible sensory evidence that will revise and improve predictions; i.e./ that I can, and am getting better. The way that we do this is via the creative content of our programmes, designed to be meaningful, compassionate and progressive.
Pudendal neuralgia is not just about the nerve. In fact, these are just words chosen to describe a particular set of signs and symptoms within a unique narrative, and each person has their own story to tell. It is about the person, their life, their state of wellness, their hopes and dreams, their connections and much more. As ever, with chronic pain, the more you focus on the pain and where it is felt, the worse the outcome. The more you focus on the person, their strengths, their dreams and picture of success, and how to get there, the better the outcome.
This is why coaching is a super way to go about it. Coaching seeks to allow the best of human potential to emerge by encouraging the use of strengths. When we are working to our strengths and managing the consequences of our weaknesses (Mike Pegg), the rest takes care of itself. We are, or should be, clinical encouragers (a blog on this soon).
Society is suffering. Chronic pain is one manifestation. The sufferings are deeply embedded in modern society. To blame a nerve or any other structure makes no sense. Instead, the whole person, asking: what is it in their life that means the pain remains dominant?
We can change people’s perception of pain rapidly using a range of visualisations, imagery, state changers and more in the clinic. How can individuals build a string of such experiences themselves in their own world, on a foundation of understanding their pain? Eliminate the fear by cultivating that understanding.
This week I asked a patient with PN what would it be like without the fear? She replied that she would be just fine if she did not have the fear. Revealing. We then practiced ways to normalise fear as an emotion, accept that it had arisen and that this was the old story based on the many wrong messages (in society) about pain and PN. The new story to focus on now, is one of growing and developing, meeting one’s needs in life, facing the tricky bits and taking steps towards a picture of success: what are the real results you want to achieve? How can you build wellness so that you can roll with life’s inevitable ups and downs. And more.
Pudendal neuralgia is not just about the nerve. Yes we need tissue health. Address the fear and any altered body sense and movements in simple ways, create the conditions to get better and have a clear picture, are some of the necessary ingredients. People can get better. They just need to know that, and then how to go about it in their own way. We have the best job in the world, contributing positively to people’s lives!