What if the words your healthcare provider used in that appointment - however well-intentioned - made your pain measurably worse?
Heather Coppard is a nurse, hypnotherapist, and author of "Optimising Recovery for Vulval and Vaginal Pain" who spent years as a patient navigating persistent vulval pain before becoming an advocate and author. Her website is heathercoppard.com (Instagram @heather_coppard). One particularly devastating medical appointment became the turning point that drove her to write her book and set up a vulval pain support group. In this episode, Heather discusses the nocebo effect, the biopsychosocial model of persistent pain, why multidisciplinary treatment was the key to her own recovery, and hypnotherapy - a modality she was initially sceptical about as a clinician.
The nocebo effect: how provider language can worsen pain outcomes
The placebo effect is widely understood - positive expectation can improve outcomes. Less discussed is its inverse: the nocebo effect, where negative expectation, framing, or language from a trusted source makes pain worse. In the context of vulvodynia and other persistent pain conditions, the words a healthcare provider uses during an appointment are not neutral. A phrase that implies permanence, hopelessness, or that the pain is the patient's fault activates threat-detection pathways in the nervous system that can increase pain and undermine recovery.
Heather's account of the appointment that changed her path illustrates this with painful clarity. The language she received - from a clinician who may not have intended harm - compounded her suffering and delayed her understanding of what was actually possible in terms of recovery. Her book and her support group work are partly built around making sure other people encounter different language at those critical moments.
"If we are told excessively that a particular drug may cause nausea and vomiting - if that message is repeated and repeated - we may well experience that nocebo side of things. The same applies to what we're told about our pain and its prognosis."
The biopsychosocial model: understanding persistent pain as multidimensional
The biopsychosocial model of persistent pain - which holds that pain is shaped by biological, psychological, and social factors together - is now the dominant scientific framework for understanding chronic pain conditions. Heather explains what this actually means in the context of vulvodynia: not that the pain is psychological or imagined, but that it is produced by a system that includes the nervous system, the immune system, past experience, current emotional state, and the social and relational context a person lives in.
This framework explains why single-modality treatment - only addressing the physical - so often underperforms. It also maps the territory of what comprehensive treatment needs to cover: the physical drivers, yes, but also the psychological impact, the relational context, and the beliefs and language frameworks a person carries about their condition.
"The biopsychosocial model of pain isn't just about the physical causes - it's looking at the whole body essentially. And the good side of that is we also know that approaching it with multifactorial treatments can be beneficial."
Why a multidisciplinary approach made the difference
Heather's own recovery involved pharmacological intervention, cognitive behavioural therapy, pelvic floor physiotherapy, and mindfulness-based stress reduction - multiple approaches working in parallel rather than sequentially. The sequencing and combination mattered: each modality addressed a different aspect of the pain system, and the combination produced something none of them would have achieved in isolation.
She discusses what multidisciplinary care actually means in practice - not just being referred to multiple specialists, but the integration of those inputs around a shared understanding of the condition. In the UK, the Vulval Pain Society and the British Society for the Study of Vulval Disease (BSSVD) are referenced as resources for people trying to access this kind of care.
"Persistent pain is often multifactorial - all different elements come together. Pain is so complex. But the good side of that is we also know that approaching it with multifactorial treatments can be beneficial - and that's exactly what a multidisciplinary approach gives you."
Hypnotherapy: from clinical scepticism to central tool
As a nurse, Heather's initial response to hypnotherapy was scepticism - a view that it occupied the soft, unvalidated end of the treatment spectrum. Her experience as a patient changed this. Hypnotherapy, she found, offered something that the other modalities she'd tried didn't: a way of working directly with the associative and predictive functions of the nervous system that are so central to persistent pain, in a way that felt both rapid and lasting.
NICE guidelines for IBS now include hypnotherapy, and there is a growing evidence base for its use in other chronic pain conditions. Heather's path from patient to practitioner in this modality is part of what gives her clinical work its particular authority - she knows what it is to approach a treatment with doubt and to find it genuinely transformative.
