Introduction
Chronic pelvic pain (CPP) is one of the most common pain conditions suffered by women and can severely affect the quality of life, including physical functioning, psychological wellbeing, and interpersonal relationships. The estimated prevalence for women of reproductive ages is between 14% – 24%, and about 14% of women experience CPP during their life [1,2]. CPP syndrome in women is multi-faceted with interconnections between organ systems, musculature, fascia, and the peripheral and central nervous system. Standard treatments often have limited effectiveness. To date, there is a broad range of complementary and alternative medicine (CAM) techniques that have been studied for the treatment of CPP. Therefore, it is essential for providers to be familiar with a range of treatment options that draw from conventional medicine, as well as complementary and alternative modalities.
List of abbreviations: CPP: Chronic pelvic pain; CAM: complementary and alternative medicine; CBT: Cognitive Behavioral Therapy; PEA: palmitoylethanolamide Review Open Access 2
JScholar Publishers J Womens Health Gyn 2020 | Vol 7: 303 Cognitive Behavioral Therapy and Mindfulness-Based Interventions
Before the 1960s, there were few, if any, unifying theories regarding why pain persists despite injury recovery or lack of identifiable tissue damage. Melzack and Wall’s Gate Control Theory is a rich and integrated theory that seeks to explain not only the physiological factors that maintain pain, but the cognitive, emotional, behavioral, and social as well [3]. Cognitive Behavioral Therapy (CBT), in conjunction with appropriate medical intervention, is uniquely suited to address these factors that perpetuate CPP. CBT is a broad term for therapies that involve a focus on changing behaviors and thoughts in order to change affective states. CBT and mindfulness-based interventions have long been recognized as effective treatments for reducing chronic pain, and a recent meta-analysis suggests that there is no significant difference in outcome between either CBT or mindfulness-based interventions for these patients [4]. Cognitive Behavioral Therapy and mindfulness-based interventions address an individual’s pelvic pain in a variety of ways. Behaviorally, participants are taught exercises such as diaphragmatic breathing and progressive muscle relaxation, to target muscle tension and accompanying anxiety [6]. Behavioral activation strategies help patients to interrupt the chronic pain cycle, and decrease associated depression. Patients are then taught to challenge catastrophic cognitions that they may experience in response to pain, which serve to increase negative emotional states. The goal of mindfulness-based interventions is not changing, but rather acceptance. Paradoxically, once patients learn to allow unpleasant sensations to come and go rather than fighting them, they often report decreases in pain.
