We appreciate the engagement of our paper by Ruan et al. Our choice to use in the title the word multimodal was deliberate and not at all intended to mislead. A quick search of PubMed shows that Labus et al and Yu et al and other teams have recently used this terminology within paper titles in the pain literature, just as we use it.

The construct of multimodal sensory testing is well established in the pain literature separately (see, for example, Rabey et al ). Multimodal as a term simply means to have or involve multiple modalities. In clinical research, this has been used not just in context to multimodal analgesia (a very important concept in perioperative pain management) but also when referring to sensory testing of animals (including humans) applying an array of different stimuli presentations (ie, pain response to pressure vs light cutaneous displacement vs temporal characteristics of pain). Obviously a synonym such as multidimensional might have served just as well.

Ruan et al are correct to review the well-known dual relevance of Aδ and C fiber involvement in pain transmission from the periphery. The evaluation of multiple fiber types using quantitative sensory testing is often beyond the financial and logistic resources of most physicians. To expand on the crude measure obtained from a global, omnibus clinical examination, our original article investigates some simple clinical tests to potentially identify the specific disrupted pathway. Likewise, although it is common to query instantaneous pain reports in response to provocation, the duration of pain after palpation rarely is investigated. If anything, this discussion of the meaning of terms supports our contention that that precise characterization of the aberrant nerve pathways responsible in individual patients is a valuable exercise. We hope to see further brisk dialogue in this arena as pelvic pain research expands.