Chronic pelvic pain syndromes have been a puzzle to the best medical minds for a century. Antibiotics, anti-inflammatories, prostate massage, and surgical procedures, which form the backbone of traditional treatments, have been of little use in dealing with these debilitating afflictions. In A Headache in the Pelvis, we describe a new treatment protocol developed at Stanford University’s Department of Urology that has stepped out of the box of conventional medical treatment. It involves a combined medical, behavioral, and physical intervention that has been successful in substantially abating the symptoms of pain and dysfunction in a select group of patients with chronic pelvic pain syndromes. This protocol is based on a new understanding that chronic pelvic pain syndromes are not caused by prostate or organ pathology but instead a chronically contracted pelvic floor that has made an inhospitable environment for the organs and tissues found within it.
This protocol is unusual because it requires the coordination of a physician, psychologist, and physical therapist. Successful results are dependent upon the willingness of the patient to actively comply with the regimen described in A Headache in the Pelvis for an extended period of time. This is in contrast to the conventional form of medical treatment which looks to a quick solution by drugs or surgery with minimal participation of the patient. The solution to this vexing condition is neither quick nor easy and requires a very large expenditure of effort. Our patients are typically people who have had pain and dysfunction for years, have seen numerous doctors, and have unsuccessfully used the conventional treatments.
While we have reached out to the medical community to educate them and to train them to use our approach, at present there are very few who can competently offer our protocol. It is for this reason that we have established these monthly clinics. They are designed to offer the most effective and comprehensive form of the treatment available described in A Headache in the Pelvis.
Perhaps the greatest suffering for patients with pelvic pain syndromes is the sense of helplessness that patients feel in the presence of their pelvic pain and dysfunction. We are not able to help everyone we treat. When we are successful in helping people with this problem, we are able to give them tools to reduce or abate their symptoms. When the treatment is successful and participants comply with the home practice portion of the protocol, some clear reduction of symptoms is usually seen within a period of three to four months. Stable reduction or abatement of symptoms can take several years and in many individuals who respond to our treatment, improvement continues with the use of the protocol.
These clinics train participants to do self-treatment at home. They are done in small groups and consist of approximately 20-30 hours of treatment over the period of 6 days. The content of the workshops consists of:
Individual medical evaluations are done in the department of Urology at Stanford University or at a participating urologist’s office prior to the intensive program, at which time the nature of the condition of the participants will be evaluated and the appropriateness of the treatment protocol determined. ** Most insurance plans cover some part of the Stanford evaluation and the extent of such coverage can be determined by the staff in the department of Urology at Stanford prior to the medical appointment at Stanford.
Training in Paradoxical Relaxation is done over a period of 5 days. The yearlong 36 lesson audio course in Paradoxical Relaxation is included in the cost of the clinic and instruction is geared to using the taped course at home. Cognitive strategies for reducing the impact of frequent negative/catastrophic thinking that accompanies chronic pelvic pain syndromes are part of the curriculum.
Participants undergo physical therapy consisting of pelvic floor related Myofascial/Trigger Point Release or physical therapy self treatment instruction on a daily basis. When a partner is available and willing, the partner receives instruction in the Myofascial/Trigger Point Release geared to the treatment requirements of the participant. Partners who come for training in Myofascial/Trigger Point Release are encouraged to attend the physical therapy sessions. This attendance is included at no extra charge. The intention of this training is to enable a partner to do this component of the protocol at home on a regular basis. Patients receive a map of their trigger points and areas of restriction. This allows the patient to give their personal pelvic trigger point map to a physical therapist in their home area that they continue to work with and/or to assist the participant’s partner do the home Myofascial/Trigger Point Release.
Participants receive information and recommendations on different aspects of treatment of pelvic pain. This information includes relevant educational material describing the physiology, anatomy, and psychology accompanying chronic pelvic pain syndromes. It includes specific stretches, referred to as pelvic floor yoga, recommendations about diet, exercise, and sexual activity. Instruction in appropriate self-administered Myofascial/Trigger Point Therapy is an important part of the curriculum. Medical evaluation is usually done by Dr. Rodney Anderson at Stanford University or other participating urologists in the San Francisco bay area. The Paradoxical Relaxation training is conducted by Dr. David Wise and the Myofascial/Trigger Point Release is conducted by senior physical therapists trained in the Stanford protocol at a site about an hour north of San Francisco.
** In the event the treatment protocol is not deemed to be appropriate at the time of the evaluation, other treatment options will be discussed, and the participant will only be charged for the cost of the Stanford medical visit. Both the relaxation training and physical therapy are done on site in Sebastopol California and have no medical/financial relationship with Stanford as participants come to Stanford for the urologic evaluation alone.
Clinic Schedule for 2012
November 29 - December 4
For information and registration
phone: 1-866-874-2225 (toll free)
National Center for Pelvic Pain, Box 54, Occidental, California 95465
Telephone: 707 874 2225 • Fax: 707 874 233
We just published an article in the Clinical Journal of Pain about our new Internal Trigger Point Wand that allows men and women with muscle based pelvic pain to do their own internal trigger point release themselves. We are currently writing up further results of our Wand study to be submitted for publication regarding how well our Wand fared compared to conventional physical therapy, how there was a significant reduction in total symptoms of men using the Wand and a reduction in the use of medications associated with using the Wand. This is not to speak of the savings in cost in using the Wand, the convenience of doing internal trigger point release at home, not having a problem in finding a competent practitioner and being able to do the internal treatment as frequently as is necessary to be able to meaningfully loosen the internal musculature. Even when muscle based pelvic pain resolves, stress typically will flare it up and knowing that they can do something to stop the pain and dysfunction and have a tool to do internal trigger point release themselves can make the difference in many people with pelvic pain between feeling helpless, hopeless, miserable and having flare up of symptoms be a minor annoyance that they know they can take care of themselves. We think the Wand is a game changer in the large majority of cases of prostatitis. Our Wand in the form of a Pelvic Pain Kit is now available in Europe and we are hoping it will be available soon in the United States. For more information, please email firstname.lastname@example.org
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