“But nothing showed up on the MRI…”
If you’ve worked with people experiencing chronic pelvic pain, you’ve likely heard this line (or screamed it into the void yourself). Pelvic pain is complex. It’s layered. And when traditional diagnostic tools come up short, patients are left confused, discouraged, and often dismissed.

This is where pain science education becomes not just helpful—it becomes essential. Especially when we’re talking about central sensitization, a sneaky, brain-driven process that keeps the pain party going long after the tissue has healed.

Let’s dig into what this means for our pelvic pain population—and why it’s time every clinician added “pain science educator” to their superpower list.

What Is Central Sensitization?
Imagine your nervous system is like a home security system. Normally, it detects real threats—say, a break-in or fire. But in central sensitization, the system is so sensitive that it goes off when a leaf blows past the window. The brain and spinal cord amplify pain signals, misinterpreting non-threatening input (like gentle touch, muscle movement, or a full bladder) as dangerous.

In the pelvic floor world, this might look like:

• Burning with urination despite no infection
• Pain with penetration, even with no visible tissue damage
• A “tight” pelvic floor that resists every stretch and cue
• General pain or pressure that moves, shifts, or seems unprovoked

Central sensitization isn’t “in someone’s head.” It’s in their nervous system—and it’s very, very real.

Why Pain Education Matters
Pain science education helps patients reframe their experience. When someone understands that pain is a protective mechanism (not a damage report), the fear cycle begins to break.

This is huge in chronic pelvic pain. Patients often carry shame, confusion, and even trauma around their symptoms. By educating them about central sensitization, we:

• Reduce fear and catastrophizing
• Improve trust in the body
• Increase compliance with movement and manual therapy
• Promote neuroplastic healing (yes, the brain can change!)

Think of it this way: You wouldn’t start strength training a rotator cuff tear without explaining what’s happening first. The same rules apply here—except our “tear” is happening at the nervous system level.

How to Integrate Pain Science into Pelvic Floor Treatment
You don’t need to be a neuroscientist or TED Talker to do this well. Here’s how we incorporate pain education into every evaluation and treatment session:

1. Use Metaphors that Stick

The alarm system analogy is a go-to. Others include:

• “Your brain is trying to protect you, but it’s become a little overprotective.”
• “Your nervous system is on high alert like a smoke detector that’s too close to the toaster.”

2. Normalize Their Experience

Validate their symptoms without reinforcing fear. “Your body is reacting in a protective way. We can help it learn to feel safe again.”

3. Introduce the Concept of Graded Exposure

Reassure them that movement, intimacy, and bladder function can return—gradually, safely, and with support. We’re not rushing into the fire; we’re slowly turning down the alarm.

4. Keep Repeating the Message

It takes time for the nervous system—and the brain—to rewire. Repeat, reframe, and reinforce education at every visit.

The Future of Pelvic Health Is Brain-Based
Pelvic pain isn’t just a musculoskeletal issue—it’s a nervous system experience. And the more we understand central sensitization, the better we can support our patients.

Pain education isn’t fluff. It’s foundational. It’s empowering. And it may just be the first real explanation your patient has ever received.

So, let’s keep spreading the word, turning down alarms, and helping patients feel safe in their bodies again.

Because healing starts with understanding—and we’ve got a lot of explaining to do (in the best way possible).

Want to dive deeper into the why behind pain?
Learn how to distinguish between peripheral pain generators and central sensitization, understand how these mechanisms show up in the body, and gain practical strategies to address them in both pelvic pain and orthopedic patients.

Join us for our remote pain science course, Pain Science for the Chronic Pelvic Pain Population on June 21-22, where complex concepts meet clear, clinical application, even including verbatim script examples with real-life patients.

AUTHOR BIO
Tara Sullivan, PT, DPT, PRPC, WCS, IF

Dr. Tara Sullivan, PT, PRPC, WCS, IF (she/her) started in the healthcare field as a massage therapist practicing for over ten years, including three years of teaching massage and anatomy & physiology. During that time, she attended college at Oregon State University, earning her Bachelor of Science degree in Exercise and Sport Science, and she continued to earn her Master of Science in Human Movement and Doctorate in Physical Therapy from A.T. Still University. Dr. Tara has specialized in Pelvic Floor Dysfunction (PFD), treating bowel, bladder, sexual dysfunctions, and pelvic pain exclusively since 2012. She has earned her Pelvic Rehabilitation Practitioner Certification (PRPC), deeming her an expert in the field of pelvic rehabilitation, treating men, women, and children. Dr. Sullivan is also a board-certified clinical specialist in women’s health (WCS) through the APTA and a Fellow of the International Society for the Study of Women's Sexual Health (IF).

Dr. Tara established the pelvic health program at HonorHealth in Scottsdale and expanded the practice to 12 locations across the valley. She continues treating patients with her hands-on individualized approach, taking the time to listen and educate them, empowering them to return to a healthy and improved quality of life. Dr. Tara has developed and taught several pelvic health courses and lectures at local universities in Arizona, including Northern Arizona University, Franklin Pierce University, and Midwestern University. In 2019, she joined the faculty team at Herman and Wallace, teaching continuing education courses for rehab therapists and other health care providers interested in the pelvic health specialty, including a course she authored-Sexual Medicine in Pelvic Rehab, and co-author of Pain Science for the Chronic Pelvic Pain Population. Dr. Tara is very passionate about creating awareness of Pelvic Floor Dysfunction and launched her website pelvicfloorspecialist.com to continue educating the public and other healthcare professionals.

In March 2024, Dr. Tara left HonorHealth and founded her company, Mind to Body Healing (M2B), to continue spreading awareness on pelvic health, mentor other healthcare providers, and incorporate sexual counseling into her pelvic floor physical therapy practice. She has partnered with Co-Owner, Dr. Kylee Austin, PT.