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In February, I attended the San Diego Pain Summit and enjoyed presentations on pain from the point of view of neurologists, physical therapists, occupational therapists, and massage therapists from around the world. At that meeting, Sandy Hilton, DPT, gave a presentation called "Practical Pain Science in the Clinic," in which she used her work with women living with chronic pelvic pain (CPP) to elucidate her approach to chronic pain patients in general. I was inspired by her talk, and decided to use the topic as a Pathology Perspectives piece, adding my massage therapy/ pathology filter. I was honored to have some follow-up time with Hilton, who provided many of the quotes used throughout this article. CHRONIC PELVIC PAIN IN WOMEN: WHAT IS IT? Imagine for a minute what it might mean to live with episodes of breathtaking pain from low in the abdomen or the pelvic floor that may occur at any time, without warning. Sometimes the pain comes while doing some terribly irritating activity like sitting, walking, or standing, and sexual activity is so painful that even thinking about it causes spasms. This problem interferes with every aspect of living—from using the toilet to dancing with a loved one. And it is hard to imagine ever feeling well; in the words of Hilton, "Fear sucks all the hope right out." CPP is an inconsistently defined, poorly understood—and therefore often inadequately managed—condition that can affect both men and women. Contributing factors may vary according to gender, but this article will focus on the condition specifically in the context of women. CPP is identified when a woman experiences nonmenstrual pain for a minimum of three months. The pain is localized to the pelvis, and it is severe enough to interfere with activities of daily living. CPP can range from being occasionally annoying to completely debilitating. And because it is usually the result of many contributing factors, no single treatment option appears to be effective for most patients. About one in every seven women will experience CPP at some point. It is estimated that this condition affects up to 39 percent of women in their reproductive years, especially ages 26–30. About 10 percent of all referrals from primary physicians to gynecologists are for CPP patients, and CPP is estimated to cost our health-care system almost $900 million each year. 42 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 education PATHOLOGY PERSPECTIVES Chronic Pelvic Pain in Women What Does Better Mean to You? By Ruth Werner

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