Adriaan Louw has done it again. He has created an easy-to-read and comprehensive reference-this time specific to pelvic pain. His first book, Why Do I Hurt? introduced readers to the concepts of neuroscience education as they applies to all pain conditions. The first book has a bit more background information about pain mechanisms and is a good adjunct to the newer book. For this text, Adriaan is joined by pelvic physical therapy specialists Sandy Hilton and Carolyn Vandyken who are the coauthors of the landmark articles "The puzzle of pelvic pain" published in the Journal of Women's Health Physical Therapy 2011;35(3):103-113.

This text begins with a discussion of the nervous system as an alarm system, how it responds to stimulation, and how the brain creates pain, and how it can become sensitive. Research has shown that when individuals are provided with an understanding of how nerves become sensitive this may decrease fear and anxiety, which can lead to decreased pain. Additional situations that can lead to sensitive nerves are also discussed in the book including failed treatments, family and job issues, ongoing pain, and no clear explanation for the pain. A review of the role of the different types of sensors (temperature, stress, blood flow, movement and pressure, immunity) adds more information and understanding about the patient's symptoms.

Section 3 is specific to pelvic pain, but unlike previous texts it does not attempt to explain every type of pelvic pain. This keeps the book understandable and patient friendly while providing just the right amount of information. I would suggest every patient education book be used in conjunction with a medical professional's treatment to individualize the teaching and treatment approach. This text allows just that. Some patients might find the measuring cup analogy confusing, but the overall information is very good.

Section 4 introduces "the lion in the room," and describes the effect of the sympathetic nervous system on the body. It also lists the multitude of symptoms patients often report including tender areas, mood swings, appetite changes, fatigue, weight gain, sleep disturbances, depression, and low sex drive. Explaining why these symptoms occur validates the patient's experience and decreases the fear that something terrible is wrong and that more tests are needed.

The last section covers treatment options in a very general way that allows the physical therapist to individualize the specific treatment for each patient. The book lists 11 treatment strategies including stress management, sleep hygiene, breathing and relaxation, aerobic exercise, graded motor imagery, manual therapy, and more.

This information is based on solid scientific evidence, and there are 43 references listed in the back of the text. The text is sympathetic to the challenges faced by patients with pelvic pain but clearly places responsibility on the patient to be an active partner in their care. This is not an instructional text for physical therapists, but it does provide wording that can be used by physical therapists in patient education. I would recommend all physical therapists who treat pelvic pain have a copy of this book in their clinic.

Beth Shelly, PT, DPT, WCS, BCB PMD

Moline, Illinois