What is Functional Pain Syndrome: Understanding the Pain “Down There…”
Since much of my practice time is spent working with and hopefully helping women saddled with pelvic and vulvo-vaginal pain and chronic fatigue issues, I thought I’d take the time to speak to the issue of vulvar and vaginal pain syndromes (“vulvodynia”) and other “Functional Pain Syndromes,” such as interstitial cystitis (“IC”), chronic fatigue syndromes (CFS), fibromyalgia, and chronic pelvic pain (CPP). This will only be a brief review; only so much can be said in several hundred words.
What is a “Functional Pain Syndrome?” Functional pain is real, perceived pain (no one is faking anything!) that has no demonstrable anatomic lesion. The operative factor in functional pain is the feedback between the central nervous system (the brain) and the autonomic nervous system—that part of the nervous system that operates “automatically” on its own with no “conscious” control.
Could chronic pelvic pain, vulvodynia, IC, Fibromyalgia, irritable bowel syndrome (IBS), and even migraines be “Functional Pain Syndromes?” Most likely, they are.
Many clinical similarities have been noted among these syndromes: pain as a prominent symptom, chronicity, overrepresentation in women, generally normal laboratory values, exacerbation by stress and menstruation, history of physical or sexual abuse, and association with depression and anxiety. Specific anatomical or pathological abnormalities are absent, and if an individual has one of these syndromes, (s)he is likely to have others.
Interestingly, these syndromes share some common findings:
- abnormalities in the hypothalamus-pituitary-adrenal axis connecting brain with adrenal gland,
- abnormalities in autonomic functioning (the functioning of the “automatic” nerves of the body over which the individual has no conscious control),
- and sensory processing (how we perceive what is going on in our bodies and react to it).
For some reason, the central nervous system in these individuals has difficulty processing the sensory input it receives.
Their many similarities and the fact that they often appear together points to these syndromes being related in some way, and they are often discussed as a group with the name: Functional Somatic Syndromes.
To better understand the impact of multiple factors on Functional Pain Syndromes, one might consider the “Biopsychosocial Model of Pain,” developed by Engel in 1977. This model takes into account the impact of the mind and body, and also takes into account the biological (physical), psychological and social influences for understanding one’s pain experience; in other words, it considers the whole person.
Understanding the Level of Pain in Functional Pain Syndrome
There are many important variables for understanding the intensity of pain a person is experiencing and how it interferes with their functioning. These include one’s beliefs about what difficulties the pain causes (e.g. “I can’t do anything because of my pain condition.”), pain behaviors and impact on activities (not enough exercise), impact on mood (e.g. depression, anger, anxiety), as well as the degree of support from one’s social network.
Not surprisingly, considering the nature of the condition, one of the most effective approaches to pain management is cognitive (thought processing) and behavioral interventions (Cognitive-Behavior Therapy or CBT).
According to CBT theory, physical reactions (e.g. pain intensity) are influenced by:
- Cognitions (thoughts, beliefs)
- Mood (depression, anxiety, anger)
- Behaviors (avoidance, withdrawal, overdoing it).
Beliefs exacerbate depressive symptoms via withdrawal from activities one used to enjoy, and anxiety escalates secondary to fear and avoidance. Additionally, the nervous tension associated with negative mood states impacts our bodies, worsening the physical intensity of the pain condition.
How CBT Treats Functional Pain Syndrome
The goal of CBT intervention is to educate individuals on the nature of their pain condition by understanding the model and cause of the pain. From there, individuals are taught how to correct their distorted pain beliefs/cognitions, adjust their pain behaviors, and treat problematic mood states. By doing this, in theory, the intensity and experience of their pain will moderate; pain will be better addressed by treating the whole person rather than focusing exclusively on “pain control.”
Mindfulness-based meditation instruction has also been proven to work wonders for Functional Pain Syndromes. Local availability for both CBT and mindfulness-based meditation programs may be obtained by accessing AACBT.org, and Googling “cognitive behavioral therapy” along with your city name, and by Googling “mindfulness-based meditation” along with your city name. Additionally, Googling “Jon Kabat Zinn” will put you in touch with mindfulness-based material from a master teacher.
(** In compiling this piece, I have relied heavily on the writings of Dr.s John W Warren, Vadim Morozov, Fred M Howard, and especially Dr. Sheryl Green.)
For more information on a wide range of topics from menopausal medicine to general health and wellness to the specific topic of labiaplasty in California, visit http://www.drmichaelgoodman.com/.