What are some key differences in underlying mechanisms between back pain and pelvic pain? 

While there are many similarities between back and pelvic pain, pelvic organs are closely connected to the pelvis in a way that abdominal organs aren’t to the back. Conditions like bladder pain syndrome or irritable bowel syndrome can drive pelvic floor, vulval and more widespread pelvic pain. Pelvic pain also touches on private or taboo things like needing the toilet urgently, leaking urine, finding sex painful or not being able to wear pants. These are deeply personal experiences and the pain that comes with them is often wrapped up in complex emotions. 

Some women describe their painful pelvic region as numb or cold. Others talk about constant pelvic floor tension or an overwhelming hypersensitivity. These kinds of experiences have also been reported in low back pain and complex regional pain syndrome, which hints at some potential shared underlying mechanisms. Given the intimate nature of the pelvic region, however, there’s much more to consider. 

How recent or established is this type of research into pelvic pain compared to similar research into back pain? 

Jilly Bond will talk about the differences between back pain and pelvic pain in her keynote presentation at APASC25.

While body perception distortion has been explored in conditions like low back pain and complex regional pain syndrome for decades, the theory has yet to translate into pelvic pain. In our recent scoping review of 175 studies, we found no evidence that sensorimotor distortion was clearly defined in the pelvic pain literature and very few studies looked at body awareness or perceptual distortions. 

However, this is changing. We recently developed, validated and used the Fremantle Perineal Awareness Questionnaire in a survey of over 700 women with pelvic pain to explore how they experience their bodies. A few groups have also started to look at treatments for pelvic pain that include body awareness. 

Pelvic pain is often linked to social aspects such as taboos associated with bodily functions and identity associated with reproduction. What impact do you feel this has on translating sensorimotor research from the back to the pelvis? 

I don’t think we can directly translate what we know about back pain into pelvic pain. Sensorimotor changes are likely relevant to some degree in both regions but the pelvis is emotionally and socially complex in a way the back isn’t. It’s tied to experiences with sex, continence, menstruation and childbirth. Pelvic functions are also more socially taboo. That stigma affects how people report symptoms, how they engage with care and whether they feel safe taking part in research, which in turn influences the data and how we interpret it. 

>> Jilly Bond is an advanced practice pelvic health physiotherapist, researcher and educator specialising in persistent pelvic pain and co-founder of the UK Pelvic Pain Network. 

>> Jilly will be presenting the keynote session ‘From the back to the pelvis: translating sensorimotor research into pelvic pain’ on Saturday 25 October at 11.40 am.

Click here for more information about APASC25