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Long term compliance: How to overcome the roadblocks.

24 August, 2014

 

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With anything in life there can be roadblocks!

Whether it’s your progression at work to the dizzy heights you believe you are entitled to; whether it’s trying to enter the housing market or simply making ends meet when you have.

But within health management, there can be many roadblocks to success and recovery from all conditions in my area of interest – pelvic floor dysfunction.

Let’s look at the treatment of persistent pelvic pain.

(I have written quite a few blogs about this already, but I am seeing so many patients with pain that I felt it warranted more on the topic of road blocks).

It may be that the patient is making good progress with understanding the complexities of central sensitization and then suddenly a jolt of pain recurs. But if the patient has been well-educated, they understand that it will not lead to a chronic increase in sensitization, because they know that the jolt is just a gentle warning to which their brain is sensitive. They now have the knowledge and capacity to prevent a jolt triggering a cascade of ungrounded fears.

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But then suddenly there are some major life stressors that arise (not unlike some of the stressors that may have been the culprits much earlier on) and the nervous system starts buzzing and zapping – there’s lots of adrenaline and cortisol being released and before the patient knows it – whambo!! back to almost as bad as the initial pain used to be! But again, they will remember – that is just the nervous system being sensitive; they can re-visit their notes, look and see what they have to do (get the dilators out, concentrate on relaxing their muscles, get back to doing some general exercise, recommence some Endep if that has worked before, paced and graded return to intercourse) and before they know it, things are back under control again.

As much as we’d always like life to be happy and ‘coming up roses’, that just isn’t what life is always going to throw at us.  In fact a full and happy life can be loaded with stress and complexity. Resilience, stress management, lots of moving and general exercise (walking, dancing, cycling, running)  and laughter (lots of dog and cat videos) will give us the ammunition to dig deep when the stress seems to be overwhelming. And like anything, to be good at coping with stress, you need to practise and rehearse regularly.

So within pelvic pain, one of the most prevalent conditions I see, is women with significant sexual dysfunction. So what are some road blocks to a successful outcome with women who present with sexual dysfunction?

  • Fear of tissue damage with the vagina.
  • Fear of increased sensitivity if they try something new.
  • Fear of moving / functioning incorrectly and increasing tissue damage  such as with intercourse.

But remembering that changes in pain are mainly related to up-regulation or down-regulation of pain, rather than any change in the state of pelvic region or vagina. This is related to their brain’s assessment of all current dangers. That is their brain working well and effectively.

 

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So what is the main challenge with long-term success with any pelvic floor dysfunction outcome?

Compliance.

Compliance with PF exercises; compliance with performing the knack (bracing) with increased intra-abdominal pressure; compliance with down-training the PF, if that is what is required; compliance with drinking non-caffeinated drinks; compliance with bladder discipline – don’t just slip off to the loo just-in-case. And compliance with practising your stress management skills. And so on.

LONG-TERM COMPLIANCE.

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(Many of the concepts within this blog have been adapted from the ‘Explain Pain’ Courses run by David Butler and Lorimer Moseley and the book ‘Explain Pain’) You can purchase the book through the link and explore more of the courses David and Lorimer run. You will not be disappointed!

 

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From → Chronic pain

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