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 over a period of 8 years at
Stanford University’s Department of Urology
that has stepped
out of the box of conventional medical treatment. It involves
a treatment that has been successful in substantially abating
or resolving 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 by a
chronically contracted pelvic floor that has made an inhospitable
environment for the organs and tissues found within it.
This
involves the coordinated treatment 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 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.
We
have established these monthly 6 day clinics to allow us to treat
in a 6 day period patients who live far away. They are 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 resolution 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 a small group 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 by urologist associated with our clinics 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.
- Training
in Paradoxical Relaxation is done over a period of 5 days. A
yearlong 48 lesson audio course in Paradoxical Relaxation is
an integral part of the instruction during
the clinic and is geared toward training participants to use the recorded
lessons of the course at home. Specific cognitive strategies
for reducing the impact of frequent negative/catastrophic thinking
that accompanies chronic pelvic pain syndromes are part of the
curriculum.
- Participants undergo a specific form of physical therapy consisting
of pelvic floor related Trigger Point Release developed for chronic pelvic pain syndromes and physical therapy
self-treatment instruction on a daily basis. When a partner
is available and willing, the partner can receive instruction in
the Trigger Point Release geared to the treatment requirements
of their partner. This attendance and instruction of
partners is included as part of the clinic cost. The intention of
this training is to train participants to self-administer the
physical therapy component of treatment at home on a regular
basis. Patients receive a map of their trigger points and areas
of restriction.
- Participants
receive information and recommendations on different aspects
of treatment of pelvic pain syndromes and are introduced to what is often seen as a new way of understanding their symptoms.
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