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44 m a s s a g e & b o d y w o r k j u l y / a u g u s t 2 0 1 6 Resources Barbosa, Hermes de Freitas et al. "The Influence of Education and Depression on Autonomy of Women with Chronic Pelvic Pain: A Cross-Sectional Study." Revista Brasileira de Ginecologia e Obstetrícia 38, no. 1 (2016): 47–52. www.dx.doi.org/10.1055/s-0035-1570107. Carinci, A. J. et al. "Complementary and Alternative Treatments for Chronic Pelvic Pain." Current Pain and Headache Reports 17 (2013): 316. Hilton, Sandy. www.entropy-physio.com/sandy-hilton. Horton, R. C. "The Anatomy, Biological Plausibility and Efficacy of Visceral Mobilization in the Treatment of Pelvic Floor Dysfunction." Journal of Pelvic, Obstetric and Gynaecological Physiotherapy 117 (Autumn 2015): 5–18. Singh, M. Medscape. "Chronic Pelvic Pain in Women." Last modified January 13, 2015. Accessed June 2016. http://emedicine.medscape.com/article/258334. WHAT WORKS FOR CPP? Because CPP is a multifactorial condition, it requires a multifactorial approach to achieve a satisfactory outcome. Women with this condition may consult a wide range of specialists, including gynecologists, urologists, surgeons, psychotherapists, physical and occupational therapists, and others, including massage therapists. The first priority is to rule out any peripheral causes of pain. This includes fairly obvious things like postsurgical adhesions or colorectal lesions, but it may also include issues that are subtler, like hidden deposits of endometriosis, or lumbar disc pressure that irritates local nerves. Once other medical problems have been ruled out or addressed, among the most important questions to ask a person with CPP are "What makes it worse?" and "What makes it better?" Even more pertinent to ask: "What does better mean to you?" In other words, "What do you want to be able to do? What does a successful outcome look like for you?" The answers vary greatly from one woman to another, depending on her priorities. This information is critical to design a treatment program that is patient-centered and likely to be successful. Research shows that when patients have a sense of autonomy—a belief in their personal power and choice about their options— their outcomes are improved. Health-care providers can use this phenomenon by educating patients about their pain, with the understanding that while progress toward improvement may not be a smooth curve, recovery is possible. In Hilton's words, therapy is built on "extreme hope, based on reality." Using education and mutual goal-setting to establish a sense of autonomy can allow the careful introduction of various therapies, including ultrasound, stretching, manipulation, hydrotherapy, and exercises to address symptoms. The patient is encouraged to identify