Six
day Comprehensive Pelvic Pain Intensive Clinics
for the Stanford Treatment Protocol
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. The clinics hope to provide the first step in
a life long shift in the way one manages the stress and other
factors related to chronic pelvic pain. 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 years. The tools of the protocol need to
be used on an ongoing basis to maintain the abatement of symptoms.
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/workshop 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
the 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 an hour north of San Francisco.
**
In the event the treatment protocol is not deemed to be appropriate,
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.
Six
Day Intensive Pelvic Pain Clinics
Northern California 2004
