Prepping The Nervous System for Surgery: How Understanding Pain Can Aid Recovery

Author: Dr Kevin Wernli (PhD), Matilda Co-founder and Pain Physiotherapist

Pain is a complex experience, and for those with endometriosis, it often extends beyond the lesions themselves. Surgery is vital for addressing the endometrial-like lesions that are key sources of pain. However, understanding the body’s broader pain system can also play a critical role in recovery. Through the Matilda Health Surgery Optimisation Program, we partner closely with surgical teams to provide holistic support, recognising both the physical and psychological dimensions of pain. Together, we ensure people are prepared to approach surgery and recovery with resilience, empowerment, and clarity.

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What is Pain, Really? It’s More Than Just Tissue Damage

It’s easy to assume that pain always equals damage, but pain is actually the body’s way of signalling perceived or actual threats. Endometriosis pain is indeed linked to lesions, which surgery works to remove or reduce. However, it’s also influenced by the nervous system and factors like inflammation, stress, and even past experiences with pain. Taking a “whole-person” approach to pain management helps in managing these influences.

Our program embraces a "biopsychosocial (or whole-person) model" of pain, considering biological, psychological, and social influences. Understanding these layers helps people make sense of their pain and build resilience for a smoother, more comprehensive recovery.

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Why the Nervous System Matters: Sensitisation and Pain

Persistent pain, like that associated with endometriosis, can cause the nervous system to become sensitised, meaning it may react strongly to minor or non-threatening stimuli. This heightened sensitivity is why pain sometimes (about 10-20% of the time) persists even after lesions are removed through surgery. Think of it as an “alarm system” in overdrive, where the nervous system may misinterpret safe sensations as painful ones, creating a lingering cycle of pain or discomfort.

The Matilda Health Surgery Optimisation Program includes strategies to help calm this sensitised response. Through mindfulness, gentle movement, and targeted education, we prepare the nervous system for surgery, supporting the body’s natural healing process and setting the stage for a smoother, more manageable recovery.

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Calming the Pain System: Pre- and Post-Surgery Preparation

1. Managing Inflammation to Ease Pain:
   Inflammation is a significant factor in endometriosis-related pain, often lingering even after lesions are addressed. Within the Matilda Health program, we provide anti-inflammatory strategies, including dietary tips and stress management techniques, to help reduce inflammation and support your body’s healing processes. Working alongside surgery, these practices can ease both pre- and post-surgical pain.
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2. Mindfulness Techniques to Calm the Nervous System
   ‍Stress and anxiety can amplify pain, heightening nervous system sensitivity. The Matilda program offers mindfulness exercises tailored to people preparing for endometriosis surgery. Practising mindfulness helps calm the nervous system before surgery and provides tools for reducing pain perception, which can give people a greater sense of control over their pain.
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3. Education on Pain Sensitivity and Management
   ‍Understanding why and how pain sensitivity develops can be empowering. Within the program, we help people make sense of how stress, lack of sleep, and past pain experiences may affect pain levels and provide actionable steps to reduce these triggers. This knowledge helps prepare the body and mind for a resilient recovery, making the journey easier to navigate.

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"A better understanding of pain before endometriosis could've helped limit suffering"
‍- Dr Kevin Wernli (PhD) reflecting on the Matilda Health Surgery Optimisation Program co-design sessions

Partnering with Surgery to Tackle Pain Holistically

Endometriosis surgery is a vital intervention, and our collaborative approach with gynaecological surgeons helps address all the factors that can influence pain, such as inflammation, stress, and nervous system sensitivity. This integrated approach supports a patient’s entire pain system—addressing both lesion-based and broader influences on pain.

By working closely with surgeons, Matilda Health enhances the surgical impact through complementary strategies that empower patients and provide a foundation for lasting relief.

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Practical Tools Alongside Surgery for Managing Pain

1. Safe Reintroduction of Movement
   ‍Movement is crucial after surgery, helping to recalibrate the nervous system and prevent excessive pain sensitivity. The Matilda Health program offers guidance on safe, gentle movements that support strength and flexibility in a safe, gradual way.
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2. Self-Compassion to Support Emotional Wellbeing
   ‍Recovery is a journey, and it’s normal to feel frustrated with lingering pain. Throughout the program, we emphasise self-compassion as a tool for maintaining a healthy mindset, even when recovery takes time. This approach reinforces the physical healing process, making the journey more manageable.
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3. Building a Supportive Environment
   Pain can be intensified by stress and isolation. Building a support network of friends, family, and healthcare providers can help promote a sense of safety and reduce pain, and is something we actively foster within the Matilda Health Surgery Optimisation Program. This supportive environment reinforces recovery, helping people feel connected, reassured, and empowered to navigate the journey with confidence.

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The Bigger Picture: Pain Beyond Surgery

Understanding that pain doesn’t always correlate directly with tissue damage is one of the most important takeaways in endometriosis care. Pelvic pain can exist in the absence of endometriosis, and endometriosis can exist in the absence of pelvic pain - understanding this can be incredibly empowering and validating to the many people that have surgery but don't end up having endometriosis (a really common fear).

Additionally, experiencing pain after surgery doesn’t necessarily mean something is wrong. Pain is multifactorial, influenced by physical, emotional, and environmental factors. Through the program, we aim to help people gain tools to manage each of these factors, enhancing their sense of control.

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Matilda Health: Working Hand in Hand with The Surgical Team

At Matilda Health, we’re proud to partner closely with our surgical colleagues, sharing a vision of whole-person care in endometriosis management. Our goal is to complement and enhance the essential work of surgeons by addressing the physical, mental, and emotional aspects of pain, providing patients with a holistic care journey.

This collaborative approach allows us to offer seamless education and support before, during, and after surgery. With the Matilda Health Surgery Optimisation program as their companion app for surgery, our goal is for people to feel equipped to face the complexity of endometriosis and be in the best position to thrive through surgery and beyond.

Pain management is a journey, and with a knowledgeable, supportive team and a deeper understanding of the pain system, people undergoing endometriosis surgery can be empowered to optimise their recovery.