Chronic Pain & Sexual Health


Dr. Kimberly Fishbach and Dr. Laura Faiwiszewski are an experts in treating chronic pain, with an approach that combines mindfulness and hypnotherapy with a variety of evidence-based techniques such as CBT, Acceptance and Commitment Therapy (ACT), and interpersonal therapy to address the emotional components of pain. Chronic pain is a multifaceted condition that can take many forms, including headaches, back and neck pain, arthritis, neurogenic pain (resulting from nerve damage), and psychogenic pain (pain existing without medical explanation). Its unrelenting and debilitating nature can rob you of the life you once knew; it can hinder your ability to engage in routine activities, such as going to work and running errands, and it can prevent you from exercising, socializing, and getting restful sleep. With increased dependency on others for support, people suffering from chronic pain can feel like a burden to those they love, which may negatively impact those relationships as well.

Seeking help for chronic pain often adds another level of frustration, requiring a significant investment of time and money to pursue the most effective remedies. Despite medications and steroid injections, procedures, use of TENS units, and visits to physical therapists, chronic pain seems to return with a vengeance. Impediments to daily functioning, combined with often futile attempts at relief, can leave sufferers feeling hopeless and with a diminished sense of identity and self-worth.

What Does Chronic Pain Have to Do with Mental Health?

It’s easy to underestimate the impact of psychological factors on pain, since chronic pain is broadly viewed as a purely physical problem. But this widespread belief has caused sufferers of psychogenic pain in particular to be stigmatized and have their experiences invalidated. The International Association for the Study of Pain (IASP) defines the experience of chronic pain as both a physiological and psychological/emotional phenomenon:  Our thoughts and feelings about pain can actually influence our sensory perception at the neural level, which indicates a powerful mind-body connection between pain and our emotions.

This mind-body connection is also found in the vicious cycle between chronic pain and anxiety/depression. In many cases, as a person’s pain increases, their engagement in activity decreases as they attempt to reduce discomfort or prevent reinjury, and this leads to maladaptive thoughts about their limitations and overall situation. The resulting anxiety and depression reinforce their inertia through avoidance and withdrawal, which further perpetuates the physical experience of pain, and in turn, feeds deepening feelings of hopelessness, uncertainty, and despair. Learning how to end this cycle and better manage your experience of chronic pain begins with learning how to identify and regulate your thoughts and emotions.

What Does Psychotherapy for Chronic Pain Entail?

Research shows that one of the most effective approaches for treating chronic pain is a combination of managing the condition and engaging in therapy to address related emotional distress. Dr. Kimberly Fishbach and Dr. Laura Faiwiszewski use Cognitive Behavioral Therapy for Chronic Pain (CBT-CP), an evidence-based approach to chronic and acute pain that has been supported by over 30 years of empirical support. To promote the most effective outcome, they incorporates additional therapeutic modalities, such as Acceptance and Commitment Therapy (ACT), interpersonal therapy, mindfulness techniques, and hypnosis to help clients redefine their relationship with pain, increase acceptance, accomplish a deeper state of relaxation, and minimize the severity of pain symptoms. While never a quick fix, the use of hypnosis in conjunction with these therapies can further facilitate relief by redirecting the mind away from pain while clients learn to relax and mitigate the mental anguish associated with physical pain.

In addition to addressing their personal experience with chronic pain, they help clients identify the cognitive and behavioral factors that contribute to the pain cycle, teach adaptive strategies to manage these factors, and empower clients to reclaim their lives and live more fully again.

Sexual Health

Dr. Karolina Pekala is an expert in treating sexual health concerns in women, with a particular interest in helping women successfully manage chronic pelvic pain. Chronic pelvic pain may be of unknown origin or caused by a medical condition, such as endometriosis, vulvodynia, vaginismus, pudendal neuralgia, or pelvic floor disorder. Symptoms may include vulvar pain, painful periods, pain with intercourse, back pain, and tense muscles in the pelvic floor, hips, and inner thighs. Pain may be triggered by seams in clothing, as a reaction to a bath product, or sitting in an uncomfortable chair - all of which can be intensified by stress. Recurrent gynecological infections can also cause irritation. It can take time for inflamed skin to heal, and another pain flare up may be triggered when the body has not had adequate time to heal before the next infection occurs.

Chronic pelvic pain and sexual health affect women in various ways and can have an impact on one or more aspects of daily life — including work, school, social, relational, and sexual activities. For instance, sitting for an extended period of time in work meetings, classes, or on an airplane can cause discomfort and make these everyday life moments extremely difficult. It can also be hard to explain why you frequently have to cancel plans or describe to family and friends what is going on. Dating and romantic relationships can cause increased anxiety - and may be difficult to negotiate as a new relationship becomes sexual or as sexual functioning in a long-term relationship changes with a medical issue.

What Does Sexual Health Have to Do with Mental Health?

While chronic pelvic pain and sexual health are often seen as medical in nature — including antibiotics, a variety of calming topical creams, physical therapy, nerve blocks, or even “just have a glass of wine” — women can find their experiences invalidated when seeking help. It can be discouraging to navigate the medical system, or even worse, to feel that a diagnosis or cure is out of reach.

Research shows that for these disorders, women often end up seeing various specialists, and it can take several years to reach an accurate diagnosis. Managing chronic pain is already difficult and depleting, and this connection between gynecological health and pain makes it more complicated and awkward to discuss in our culture.

Dr. Karolina Pekala offers an empathetic therapeutic space in which women can discuss their pain openly. Her unique approach blends psychoeducation, pain-minimizing techniques, and a CBT perspective to change the client’s view of pain, which in turn, affects and alleviates the way in which they experience pain.

What Does Psychotherapy for Sexual Health Entail?

Decades of research shows that an empathic, multifaceted approach to chronic pain and sexual health concerns results in the best outcomes. Clients with chronic pelvic pain may get stuck in a pain cycle, and Dr. Pekala works to break that cycle. As studies have shown, hypnosis is a highly effective therapy for chronic pain. Dr. Pekala’s approach offers relief through a variety of techniques, including hypnotic induction. She also provides her clients with skill training to improve their general wellbeing and reduce the severity of pain and suffering when it occurs.

Dr. Pekala also works with couples and family members who want to learn more about these conditions and support their loved ones in an effective manner. And while eliminating pain completely may not be possible, Dr. Pekala strives to help women regain control of their daily lives, develop a pain action plan, and experience relief both physically and emotionally.

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