Essays on Pelvic Pain – WHY INTRAPELVIC BIOFEEDBACK MEASUREMENT IS NOT A RELIABLE INDICATOR OF THE USEFULNESS OF THE STANFORD PROTOCOL AND THE ISSUE OF THE THERAPEUTIC USEFULLNESS OF PELVIC FLOOR BIOFEEDBACK

David Wise, Ph.D.

I am responding to a request for a comment about the usefulness of INTRAPELVIC biofeedback measurements in determining if pelvic pain is a tension disorder and appropriate for the Stanford Protocol. My short answer is that electromyographic measurement of the anal sphincter with a biofeedback anal probe, used alone, is an unreliable measure of what is going on inside the pelvic floor. Unremarkable readings of the anal sphincter should not be used to rule out tension disorder prostatitis and pelvic pain nor to dismiss the appropriateness of a treatment of the Stanford protocol.

The following are excerpts and abstracts of publications regarding the latest CPPS and Wise-Anderson Protocol research:

The following is an abridged version. For the full version, see the link at the bottom.

Department of Urology, School of Medicine, Stanford University, Stanford, California.

PURPOSE: A combination of manual physiotherapy and specific relaxation training effectively treats patients with chronic prostatitis/chronic pelvic pain syndrome. However, little information exists on myofascial trigger points and specific chronic pelvic pain symptoms. We documented relationships between trigger point sites and pain symptoms in men with chronic prostatitis/chronic pelvic pain syndrome.

MATERIALS AND METHODS: We randomly selected a cohort of 72 men who underwent treatment with physiotherapy and relaxation training from 2005 to 2008. Patients self-reported up to 7 pelvic pain sites before treatment and whether palpation of internal and external muscle trigger points reproduced the pain. Fisher’s exact test was used to compare palpation responses, ie referral pain, stratified by reported pain site.

“The goal of the Wise-Anderson Protocol is to enable the patients to reduce and/or resolve their symptoms without dependency on drugs or others to do so for them.”

David Wise, Ph.D.
Plenary address to the
National Institutes of Health (NIH)
Scientific Workshop on Prostatitis/Chronic Pelvic Pain Syndromes
Baltimore, Maryland
October 21, 2005

Introduction
Thank you for giving me the opportunity to discuss the Wise-Anderson Protocol at this National Institutes of Health sponsored scientific meeting on Prostatitis/Chronic Pelvic Pain Syndrome.

The purpose of Paradoxical Relaxation in the Wise-Anderson Protocol is to teach a patient to profoundly relax the tensed and shortened muscles within the pelvic floor basin associated with certain kinds of pelvic pain. It involves a daily practice of the cultivation of effortlessness in the presence of pain, anxiety, and tension in order to abate them.

The Wise-Anderson Protocol began when Dr. David Wise, a psychologist in California who had suffered from Chronic Pelvic Pain Syndrome for many years, contacted several urologists including Dr. Rodney Anderson, a professor of Urology at Stanford University School of Medicine and a leading practitioner and expert in the field of pelvic pain. Dr. Anderson was considered to be the court of last resort for patients with pelvic pain and prostatitis who had not been helped by any other treatment.

We have identified a group of chronic pelvic pain syndromes that we believe is caused by the overuse of the human instinct to protect the genitals, rectum, and contents of the pelvis from injury or pain by contracting the pelvic muscles. This tendency becomes exaggerated in predisposed individuals and over time results in chronic pelvic pain and dysfunction. The state of chronic constriction creates pain-referring trigger points, reduced blood flow, and an inhospitable environment for the nerves, blood vessels, and structures throughout the pelvic basin. This results in a cycle of tension, anxiety, and pain, which has previously been unrecognized and untreated.

Studies have shown that myofascial trigger points that are found in sore and painful muscles inside the pelvic floor are strongly affected by slight degrees of stress. Gevirtz and Hubbard did electromyographic monitored studies of the electrical activity of trigger points and their relationship to stress. Even the slightest increase in anxiety and nervous arousal caused a significant increase in the electrical activity of the trigger points being monitored. Individuals suffering from pelvic pain often report an increase in pelvic pain symptoms with stress and a decrease of pelvic pain symptoms with the reduction of stress and anxiety. It is for this reason that the Wise-Anderson Protocol trains patients in a relaxation method that regularly reduces anxiety and nervous system arousal.

Most cases diagnosed as prostatitis are problems of chronically tightened muscles of the pelvis and not  problems of the prostate gland

While we treat both men and women with pelvic pain, a large majority of men with pelvic pain are diagnosed with prostatitis.  Most men diagnosed with prostatitis have mistakenly been told that their symptoms are cause by a problem of their prostate gland.  In fact the problem of genital, rectal, perineal pain , urinary symptoms, sitting discomfort, (click here for symptoms of prostatitis) in most men has nothing to do with the prostate gland.