Pain Neuroscience Education and Basic Body Awareness Therapy in Women With Chronic Pelvic Pain

Pressure Pain Threshold and Pain Tolerance

Pressure pain threshold and tolerance will be assessed using a Baseline® manual algometer. Standardized measurement points will be located in the abdominal and pelvic regions (15 points in total). Pressure will be applied perpendicularly at a rate of 1 kg/s until the participant reports the first pain sensation and maximum tolerable pain. The mean of two measurements per site will be used for analysis. Distal control points (C5-C6 zygapophyseal level, second metacarpal, and tibialis anterior muscle) will be included to evaluate widespread pressure sensitivity as an indicator of central sensitization.

Pain Intensity and Characteristics (Short Form McGill Pain Questionnaire)

Pain intensity and characteristics will be assessed using the Short Form McGill Pain Questionnaire (SF-MPQ). The SF-MPQ evaluates both sensory (11 items) and affective (4 items) dimensions of pain through 15 descriptors rated on a 4-point scale (0 = none to 3 = severe). It also includes a Visual Analog Scale (VAS) and a 6-point Likert scale assessing overall pain intensity (0 = no pain to 5 = unbearable pain). Total scores will be calculated for sensory, affective, and overall dimensions.

Pain Catastrophizing (Pain Catastrophizing Scale)

Pain catastrophizing will be assessed using the Pain Catastrophizing Scale (PCS), a 13-item self-report questionnaire developed by Sullivan et al. to measure negative cognitive and emotional responses to pain. Each item is rated on a 5-point Likert scale (0 = not at all, 4 = all the time), with total scores ranging from 0 to 52. Higher scores indicate greater levels of catastrophizing. The PCS includes three subscales: rumination, magnification, and helplessness.

Autonomic Nervous System Responses - Tonic Skin Conductance Level (SCL)

Resting tonic skin conductance level will be recorded using the Shimmer3 GSR+ device with electrodes placed on the hypothenar region. Higher SCL indicates increased sympathetic arousal.

Pain-Related Beliefs (Pain Beliefs Questionnaire)

Pain-related cognitive beliefs will be assessed using the Pain Beliefs Questionnaire (PBQ), which evaluates individuals' beliefs about the causes, meaning, and controllability of pain. The PBQ consists of two subscales: organic beliefs (the idea that pain indicates tissue damage) and psychological beliefs (the idea that pain is influenced by emotional and mental processes). Each item is rated on a 6-point Likert scale (1 = never, 6 = always), with higher scores indicating stronger beliefs in each domain. The questionnaire will be used to assess changes in pain-related cognitions and cognitive restructuring following the interventions.

Pelvic Floor Symptoms (Global Pelvic Floor Bother Questionnaire)

Pelvic floor dysfunction-related symptoms will be assessed using the Global Pelvic Floor Bother Questionnaire (PFBQ). This questionnaire evaluates the severity of pelvic floor symptoms and their impact on daily life, including stress urinary incontinence, urinary frequency, urgency, urge incontinence, voiding difficulty, pelvic organ prolapse, obstructive defecation, fecal incontinence, and dyspareunia. Each symptom is answered as "Yes/No," and if "Yes," participants rate the bother level from 1 (not at all) to 5 (a lot). The total score ranges from 0 to 45, with higher scores indicating greater symptom severity or bother.

Female Sexual Function (Female Sexual Function Index)

Female sexual function will be assessed using the Female Sexual Function Index (FSFI), a validated, multidimensional questionnaire developed by Rosen et al. It consists of 19 items rated on a 5-point Likert scale and evaluates six domains: desire, arousal, lubrication, orgasm, satisfaction, and pain. Total scores range from 2.0 to 36.0, with higher scores indicating better sexual function. A cutoff score of 26.55 differentiates between normal and dysfunctional sexual function.

Depression, Anxiety, and Stress Levels (Depression Anxiety Stress Scale-21)

Depression, anxiety, and stress levels will be assessed using the Depression Anxiety Stress Scale-21 (DASS-21), a reliable 21-item self-report questionnaire developed by Lovibond \& Lovibond and validated in Turkish by Yılmaz et al. (2017). The scale includes three subscales-depression, anxiety, and stress-each with seven items rated on a 4-point Likert scale (0 = did not apply to me at all to 3 = applied to me very much). Higher scores indicate greater emotional distress. Severity for each subscale is categorized as normal, mild, moderate, severe, or extremely severe.