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What do I do with my trigger points now, Dr Quintner?

Author:

John Quintner, Professor Milton Cohen and Dr Geoffrey Bove recently published a very controversial review – A critical evaluation of the trigger point phenomenon. Their article aims to show the hypothesis – “Myofascial Pain arising from Trigger Points” – formulated in the 1980s by Travell and Simons, is ‘flawed both in reasoning and in science’.

Being closely aquainted to John (albeit via cyberspace), I sought a patient’s explanation. What does this mean for me and others with chronic pain erroneously attributed to myofascial trigger points?

How many years have you been practising and researching chronic pain?

I commenced my career in rheumatology in 1975. My interest in chronic pain dates from 1985, when I admitted to myself that I had no idea about what was then being called “RSI”. Without a research background I was left with no other option but to learn “on the job”. I remember that some of my rheumatology colleagues would laugh at those of us who were making a serious effort to understand these conditions. But these were extraordinary times when a fierce debate over the validity of “RSI” as a compensable condition was raging across Australia.

Do you believe pain will be explained one day?

The short answer is NO. Attempting to explain the experience of pain is inextricably linked to our inability to explain consciousness. You could ask if we will ever explain LOVE and I would give you the same answer.

What might your research mean for someone with chronic pain?

Along with those with whom I have collaborated, and the list includes Professor Milton Cohen, Mr Robert Elvey and Dr Geoffrey Bove, my research has been aimed at shining the torch of critical scientific inquiry upon a number of complex and poorly understood conditions. From our attempts to do so, I hope that in some small way we have helped people in chronic pain to avoid the stigma that is so often conferred upon them by members of our society, including their well-meaning medical and other health professionals. Continue Reading

Intensive 6-day Wise-Anderson Protocol Clinics

Author:

I was referred to two pain management centres in Melbourne. One doctor was happy with my own pain management routine and the other team asked that I agree to accept responsibility for my chronic pain and that I will forget having future x-rays, mri’s etc. if I was going to participate. Well as if I was going to go for that? As reputable as the centre was it didn’t sound right for me and as it turned out, it wasn’t.

This sounds a little more appropriate for me.

Source: chronicprostatitis.com

Intensive 6-day Wise-Anderson Protocol Clinics

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. 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:

  1. 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.)
  2. 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.
  3. 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.
  4. 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 Wise-Anderson 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.

Six Day Wise-Anderson Protocol Intensive Pelvic Pain Clinics Northern California

2011
January 27-Feb 1
March 3 – 8
April 7 – 12
May 19 – 24
June 23- 28
July 14 – 19
August 11- 16
September 22 – 27
October 20 – 25
November 10 – 15
December 8 – 13

Contact information
For information and registration
phone: 1 866 874 2225 (toll free)
1 707 874 2225

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Definitions of pain

What is Pudendal Neuralgia (PN)?
Most simply put PN is Carpal Tunnel in the pelvis/buttocks. Compression of the Pudendal Nerve occurs after trauma to the pelvis and is aggravated with pressure. The pain is often described as a toothache like pain, with spasms, sensations of tingling, numbness, or burning. It can be very debilitating.

What is Neuropathic pain?
Neuropathic pain is the result of an injury or malfunction in the peripheral or central nervous system. The pain is often triggered by an injury, but this injury may or may not involve actual damage to the nervous system. More…

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