I want to push back on a word. Just one word, but it’s done more damage in this space than almost anything else: managing.
You’ve probably heard it from every provider you’ve ever seen. “Let’s find a way to manage your symptoms.” “Here’s a management plan.” Managing is treated as the ceiling. The best-case outcome. The thing you should feel grateful for if you get it.
I don’t think managing is the ceiling. I think it’s been sold to you as the ceiling because it’s an easier promise to make, and often an easier outcome to sell, than actual healing.
What “managing” actually looks like, day to day
Managing looks like a color-coded system of safe foods and risky foods that you re-check every time a new symptom shows up. It looks like a heating pad you never travel without, tucked into your bag next to your phone charger, treated as a permanent fixture of your life rather than a temporary tool. It looks like knowing the exact seat in every restaurant, every car, every waiting room that hurts the least, and quietly steering yourself there without ever mentioning why. It looks like modifying your exercise routine to the “safer” one while choosing the comfortable workout outfit over the sexy one.
It looks like getting good, really good, at coexisting with something you were told would never actually go away.
Nobody ever explicitly says “this is permanent, stop hoping for more.” But the entire architecture of “managing” implies it. You don’t manage a cold. You manage something you’ve accepted is staying.
Here’s what the actual science says about that assumption
A lot of chronic pelvic pain, once tissue-level causes have been ruled out or treated, is sustained by something called central sensitization — a form of neuroplasticity where the central nervous system becomes hyperexcitable and starts amplifying pain signals beyond what the original tissue issue would explain. That word, neuroplasticity, is the part I want you to sit with for a second. Plasticity means changeable. It’s the same property of the nervous system that allows you to learn a language or recover a skill after injury. It is not, by definition, a fixed, permanent state that can only be “managed.”
Research on central sensitization backs this up in a way I find genuinely validating. Studies looking at central sensitization and treatment outcomes have found that patients with higher central sensitization scores tend to have worse outcomes from purely structural interventions, things like surgery, injections, or procedures aimed only at the tissue, compared to patients with lower central sensitization. There’s no way that’s a coincidence. It’s because those treatments are aimed at the wrong layer of the problem. If the amplification is happening in the nervous system, treating only the tissue underneath it will keep producing the same frustrating, partial results that “managing” has trained you to expect.
On the other side, research on approaches like pain neuroscience education, which teaches patients what’s actually happening in their nervous system, paired with other rehabilitation methods, has shown measurable improvements not just in pain intensity but in disability and pain-related cognition. In other words, when the actual mechanism gets addressed instead of just the symptom sitting on top of it, things change in ways that pure symptom management doesn’t achieve.
Why I think the word “managing” gets pushed so hard
I don’t think this is some grand conspiracy. I think it’s simpler and sadder than that: managing is a realistic, deliverable promise inside a healthcare system that often doesn’t have the time, training, or reimbursement structure to address the nervous system piece. It’s genuinely easier to hand someone a management plan than to walk them through retraining a threat-detection system that took years to build. So management becomes the thing that gets offered, not because it’s the ceiling of what’s possible, but because it’s the floor of what’s practical to deliver in a fifteen-minute appointment.
That’s not anyone’s villain origin story. But it does mean the word “managing” has quietly become a stand-in for “healing,” when the two are not the same thing at all, and you deserve to know the difference.
The distance between those two words, in my own life
For years I was excellent at managing. I could tell you exactly which restaurants had food and chairs I could tolerate. I had a heating pad in my bed, my office, and my overnight bag, permanently, the way other people have chapstick. I didn’t think of any of this as sick. I thought of it as competent.
Healing looked completely different, and honestly, smaller and less impressive from the outside. It wasn’t a better system for managing my triggers. It was slowly teaching my nervous system, through small repeated experience, that it didn’t need to stay on high alert anymore. It was less “here are my seventeen coping tools” and more “I don’t need twelve of these anymore, because my body isn’t sounding the alarm as often.”
I don’t think I was ever meant to become a lifelong expert at managing my own alarm system. I think I was meant to help it stop going off so often in the first place. That’s a different goal, a different measure of success, and honestly, a much smaller life if managing is where you stop.
Your pain can be real, your management tools can genuinely help in the moment, and you can still want something bigger than becoming excellent at coexisting with a body you were told to just accept.
Research + Further Reading
Your pain deserves to be taken seriously — with compassion, nuance, and evidence. These resources helped inform the science shared in this article.
Sources
ScienceDirect — Central Sensitisation in Chronic Pain Conditions: Latest Discoveries and Their Potential for Precision Medicine
PMC / National Institutes of Health — Prevalence of Central Sensitisation Associated Symptoms and Associations With Treatment Outcomes in Surgical, Interventional, and Injection-Based Treatment for Chronic Spinal Pain
PMC / National Institutes of Health — Soft-Tissue Mobilization and Pain Neuroscience Education for Chronic Nonspecific Low Back Pain With Central Sensitization: A Prospective Randomized Single-Blind Controlled Trial
Springer Nature Link — Advances in Targeting Central Sensitization and Brain Plasticity in Chronic Pain
Quick Note
The information shared here is for educational purposes only and is not intended to diagnose, treat, or replace medical, nutritional, or mental health care. Chronic pelvic pain can have many contributing factors, so please work with a qualified provider to rule out anything that needs medical support.
