The Puzzle of Pelvic Pain—A Rehabilitation Framework for Balancing Tissue Dysfunction and Central Sensitization, I

Chronic pelvic pain is associated with physiological, psychological, and social challenges. Using current concepts from pain sciences and evidence-based treatment strategies, physical therapists are ideally positioned to be a critical part of a comprehensive treatment plan for chronic pelvic pain. We propose a framework for the understanding and evaluation of chronic pelvic pain. This framework is grounded in basic and clinical pain sciences and in the biopsychosocial model. The framework integrates the current understanding of local tissue complaints with the wider context of sensitized protective mechanisms within the spinal cord and brain. Treatments address both the local tissue complaints and the central nervous system sensitivity by teaching patients about the biological processes underpinning their pain, graded imagery, and graded exposure.