After greeting my new client Mrs. L., we sat across from each other in an area of my treatment space reserved for listening and learning. The beginning exchange with a new client is a profoundly special and often powerful experience—one that I cherish deeply.
Mrs. L. recounted that her experience with pelvic pain began about three years ago after a supposedly routine surgery. Unfortunately, the pudendal nerve was traumatized during the procedure and the symptoms began a month or two later. Her pain was an annoyance at first, then escalated gradually, increasing in both intensity and frequency. Workouts became more difficult, and, as time progressed, even long walks provoked her symptoms. The longer the pain persisted, the more fatiguing it became for her. Like many people in pain, she also felt this negatively affected her cognitive abilities; she noticed that her clarity of thinking and memory skills were diminished. As Mrs. L. recounted the many ways this pain had affected her life, her voice faltered and she began to cry. After a long silence, she regrouped and made complete and forceful eye contact.
“I need to show you something,” she said, pulling two pictures out of her purse. “This is me,” she said, handing them to me. “This,” she said, waving her arm across her body, “is not who I am.” While the tears began again, her eyes did not waver from direct eye contact with me. It was very clear she didn’t want me to simply glance at the photos; she wanted me to fully get what she was telling me.
The pictures were indeed stunning. Taken only a few years previous, the pictures revealed a woman who was fit and vivacious, with an infectious smile. I would not have guessed these pictures were of the person sitting in front of me. Mrs. L. kept looking at me without saying a word, her eyes searching mine to see if I understood the gravity of what she was trying to communicate. I held my gaze on the pictures for a long time, sensing that was what she needed.
In this silence, my thoughts were lost in the reality of how chronic pain can devastate one’s sense of self-identity. Mrs. L.’s sense of herself was that vivacious person in the photos, which is why she carried them everywhere she went. Those photographs were a reminder that the person she was at that moment was not who she believed herself to be.

Know Where You Are
Sense of self is at the core of physical and emotional health, and this is an aspect of health upon which chronic pain can wreak great havoc. The dissonance between these two images of self—one present and one past—is the source of untold internal struggle and pain. It would be a different story if, over time, one stopped exercising and subsequently gained weight. It is a very different thing when this happens to you, produced by circumstances out of your control.
I am sad to say that Mrs. L., like many other people in chronic pain, did not have a great experience with the health-care providers who were assigned to her care. Mostly, she felt invalidated by the way they related to her. Some were dismissive, some didn’t listen, others just did not seem to care. Like that old saying, people don’t care how much you know until they know how much you care. For people in chronic pain, it isn’t just the symptoms they feel, it is largely about the impact of the pain on their perception of self. Until that is acknowledged, it is difficult to progress. Like a GPS system, to get where you want to go, you also need to know where you are. Listening and acknowledging are the beginning steps of that path; the client must sense that you understand their current reality. Once that is established, real progress can happen. For Mrs. L., she needed me to sense not only where she was when she entered my office, but also where she came from.
Pudendal nerve issues are extremely complicated; perhaps by the time this article is published, I will know whether we are making progress. My goal is to make movement more comfortable and slowly increase her activity level. While I do not know what the outcome will be, I do know that Mrs. L. felt heard and validated after our first appointment. Acknowledging her dignity as a person was the first step to healing.
After she left, I kept thinking about a quote from Ambroise Paré, a French barber-surgeon who lived in the 1500s, who was also channeling Hippocrates: “The ultimate duty of the physician is to ‘cure occasionally, relieve often, console always.’”
This is timeless wisdom for all of us in health care.  

Douglas Nelson is the founder and principal instructor for Precision Neuromuscular Therapy Seminars, president of the 16-therapist clinic BodyWork Associates in Champaign, Illinois, and a trustee for the Massage Therapy Foundation. His clinic, seminars, and research endeavors explore the science behind this work. Visit www.nmtmidwest.com, or email him at doug@nmtmidwest.com.