Helping Patients Shift Perspectives on Pelvic Pain: A Motivational Interviewing Approach

Are some of your pelvic patients unsure or resistant to the idea that emotions and stress could be contributing to their pain?

Science shows that pain can morph into persistent pain if the nervous system barrages the brain with threat messages. Threats can be negative, scary thoughts, disagreements with a partner, self-criticism, financial worries, etc. If the brain gets too many threat messages, it learns a faulty overprotective pattern over time, sending pain and muscle tension to keep the body safe.

As defined by the International Association for the Study of Pain (IASP):
👉 "Pain is an unpleasant sensory and emotional experience associated with or resembling that associated with actual or potential tissue damage."

So, how do we help patients explore this idea without feeling dismissed or gaslit?

Motivational Interviewing (MI) offers a collaborative way to do just that.

Here's a sample MI-informed exchange:

Patient:
"I don't think this is emotional. I want physical treatment."

Provider:
"It makes sense to want physical support. Would it be okay if I shared something from pain science?"

Patient: "Sure."
Provider:
"We're learning that the nervous system can keep pain signals active even without ongoing physical injury. Emotional stress, fear, and past trauma can amplify this loop.

Pain is never imaginary—rather a physical sensation due to a faulty, overprotective pattern by the nervous system and brain, which can change.

Have you noticed if stress increases your pain?"

Patient: "Yes—during a stressful time, my pelvic pain got worse."
Provider:
"That's a useful insight. It means we can support you physically and work on calming the nervous system to reduce pain."

This kind of exchange respects the patient's view, offers a science-based context, and opens new doors for care.
PelvicSense includes motivational interviewing during Evelyn's individual private coaching sessions and group Zoom meetings. By combining MI and nervous-system-informed care, we build better partnerships and outcomes.

📖 Apkarian AV et al., Eur J Pain, 2005.
"Pain is a multidimensional experience… Psychological factors such as fear, stress, and trauma play a significant role in pain chronicity."