"I wish I knew then what I know now": pain science education concepts important for female athletes

Key points

1. 0120 women with improved pelvic pain described four core pain science concepts as central to their recovery
2. 02Learning that pain is driven by a sensitised nervous system - not always tissue damage - was highly validating, especially after years of dismissal by clinicians
3. 03Understanding that thoughts, language, and emotions can amplify pain helped participants adopt self-management strategies such as cognitive reframing, mindfulness, and exercise
4. 04Learning that pain can change slowly through neuroplasticity gave hope and empowerment, motivating persistence with self-management
5. 05Participants stressed that education must be paired with practical strategies - information alone felt disempowering or disrespectful

How it was conducted

Design

Qualitative study using semi-structured interviews with reflexive thematic analysis

Participants

20 adult females in Australia who self-identified as having improved pelvic pain and had engaged with pain science education

Diagnoses

Endometriosis (80%), chronic pelvic pain syndrome (40%), adenomyosis (20%), bladder pain syndrome (10%), vulvodynia (10%), dysmenorrhoea (10%), pudendal neuralgia (5%); 60% had multiple diagnoses

Recruitment

Purposive sampling via social media groups and private pelvic health physiotherapy clinics

Interview timing

Conducted September to February; all interviews conducted online via Zoom

Analysis

Braun and Clarke reflexive thematic analysis with inductive coding in NVivo; critical realist ontology

What they found

• Four themes were generated: (1) a sensitised nervous system leads to overprotective pain; (2) pain does not have to mean the pelvis is damaged (although sometimes it does); (3) how I think, feel, and see my pain can make it worse; (4) I can change my pain slowly
• 90% of participants reported self-directed learning (books 75%, social media 35%, websites 30%) as a PSE delivery method
• 85% received PSE from a health professional (physiotherapist 65%, gynaecologist 30%, pain specialist 30%, psychologist 30%)
• 55% used visual aids (diagrams 55%, models 15%) as part of PSE engagement
• 30% attended a pain course or workshop; 20% attended a pain program
• All participants described valuing the biological explanation of pain as validating their experience, particularly contrasting with prior dismissal by healthcare professionals

Limitations

• Sample was relatively homogenous: most participants were aged 35 or younger, held at least a bachelor degree, lived in urban areas, and had endometriosis - limiting generalisability
• Sample was predominantly WEIRD (Western, Educated, Industrialised, Rich, Democratic), consistent with limitations in much prior PSE research
• PSE dose and delivery methods were not standardised; variability in how participants engaged with PSE influenced which concepts they found important
• The study only included women who improved and engaged with PSE, so the perspective of those who did not improve or did not use PSE is absent

Why it matters

For patients

Women with pelvic pain may find it helpful to seek out pain science education that explains how the nervous system works, as this understanding helped other women feel validated, less fearful, and more in control of their pain.

For clinicians

Clinicians treating pelvic pain should deliver pain science education that explicitly addresses the role of a sensitised nervous system, the imperfect link between pain and pathology, psychosocial influences on pain, and neuroplasticity - and should pair this education with practical self-management strategies rather than providing it in isolation.

For readers

This study provides the first direct qualitative account of which pain science education concepts women with pelvic pain found meaningful, offering an empirical basis for tailoring PSE curricula to this population rather than adapting content designed for musculoskeletal pain.