by Caroline F. Pukall, PhD, CPsych [bio]
Trying to figure out the “cause” of most chronic pain conditions is never simple. Often, the original cause has long resolved, disappeared, or was a mystery to begin with. And it really isn’t as simple as finding that “one thing” that “caused” the issue and that — if identified — can be “fixed” such that a “complete cure” can be expected. It’s unfortunate that it isn’t that simple. I wish it could be, and I know that most, if not all, chronic pain patients have the same desire. “I just want to go back to who I was/what my life was like before the pain started” is a common plea heard by many healthcare professionals who work with chronic pain patients. If only there was a magic wand of some sort…but alas, these are only functional in movies.
The problem is that the cause of the chronic pain, even if identified, is like a moving target. It is a process in and of itself; it doesn’t just sit there, alone, in its own bubble. It affects other systems, both physiological and psychological, and creates changes on a larger scale, generating a vicious cycle of pain. Within this cycle, many other factors become implicated in contributing to the pain experience, either directly or indirectly. Take the feelings of hopelessness and catastrophizing in someone with vulvodynia (unexplained chronic vulvar pain), for example. Thoughts such as “this pain will never go away”, “this pain is the worst thing ever”, and “I can’t do anything to control this pain” can make the pain feel more intense and set the person back in terms of activity levels and treatment response. Depressive symptoms may then ensue. Relationships with others might be affected. Sexual desire and frequency will likely decrease. Heightened muscle tension in the pelvic floor can occur. And, unfortunately, none of these biopsychosocial factors usually helps lessen the pain experience.
The focus of my talk in 2017 will be on the biopsychosocial factors involved in the expression of vulvodynia. It is my hope that attendees will understand these factors and the complex interactions among them, as well as the specific psychosocial impact of vulvodynia. I will also discuss the importance of adopting brief, useful measures in practice that can allow for the multidimensional assessment of vulvodynia, with a view to aid in terms of treatment approach (e.g., concurrent treatment, referrals, psychoeducation) and outcome. Looking forward to seeing you there!
Dr. Caroline Pukall, a Clinical Psychologist, is Professor of Psychology, Director of the Sexual Health Research Laboratory (sexlab.ca), and Director of the Sex Therapy Service (Queen’s Psychology Clinic) in the Department of Psychology at Queen’s University. She is cross-appointed with the Centre for Neuroscience Studies, the School of Rehabilitation Therapy, and the Department of Biomedical and Molecular Sciences. Caroline collaborates extensively with others with various backgrounds (e.g., gynecology, neurology) within and outside of Queen’s University.
Caroline’s research focuses on human sexuality, with a particular focus on genitopelvic pain conditions (including vulvodynia, postpartum pain, and gynecological pain), sexual difficulties, sexual health, sexual arousal (including methodologies and persistent genital arousal disorder), and diverse relationships. She applies a multimethod approach in many areas of research, tackling complex clinical issues with sophisticated research designs that consist of multiple methodologies such as brain imaging (functional and structural), psychophysics, psychophysiology, and blood flow imaging, relating the findings of these methods to a variety of self-report measures. Caroline has also conducted research into vulvodynia treatments, examining the effectiveness of psychotherapy and pelvic floor physical therapy via multiple methods, and she is keenly interested in outcome measures in vulvodynia. Caroline has published over 70 peer-reviewed papers, 3 books, over 20 chapters, and has been involved in over 90 invited presentations and over 170 conference publications. Her research has been funded by several organizations including the Canadian Institutes of Health Research and the National Vulvodynia Association.
Caroline is on the editorial board of several journals, including The Archives of Sexual Behavior, The Journal of Sex and Marital Therapy, and The Canadian Journal of Human Sexuality, and she is an Associate Editor of Sexual Medicine Reviews. She was co-chair of the Women’s Sexual Pain Disorders Committee of the International Consultation of Sexual Medicine (2013-2015) and was an Advisor to the DSM-5 Task Force and Work Group for the Sexual Pain Disorders diagnostic criteria. In the Sex Therapy Service, Caroline trains student therapists on sex therapy techniques for clients who have sexual, relationship, and/or gender issues.