Abstract
Appl Psychophysiol Biofeedback DOI 10.1007/s10484-015-9273-1
February 2015

Chronic Pelvic Pain Syndrome: Reduction of Medication Use After Pelvic Floor Physical Therapy with an Internal Myofascial Trigger Point Wand

R. U. Anderson Stanford University School of Medicine, Stanford, CA 94305, USA e-mail: rua@stanford.edu: R. H. Harvey Department of Health Education, San Francisco State University, San Francisco, CA, USA D. Wise _ T. Sawyer National Center for Pelvic Pain Research, Sebastopol, CA, USA; J. Nevin Smith Sonoma, CA, USA; B. H. Nathanson OptiStatim, LLC, Longmeadow, MA, USA_

This study documents the voluntary reduction in medication use in patients with refractory chronic pelvic pain syndrome utilizing a protocol of pelvic floor myofascial trigger point release with an FDA approved internal trigger point wand and paradoxical relaxation therapy. Self-referred patients were enrolled in a 6-day training clinic from October, 2008 to May, 2011 and followed the protocol for 6 months. Medication usage and symptom scores on a 1–10 scale (10 = most severe) were collected at baseline, and 1 and 6 months. All changes inmedication use were at the patient’s discretion. Changes in medication use were assessed by McNemar’s test in both complete case and modified intention to treat (mITT) analyses. 374 out of 396 patients met inclusion criteria; 79.7 % were male, median age of 43 years and median symptom duration of 5 years. In the complete case analysis, the percent of patients using medications at baseline was 63.6 %. After 6 months of treatment the percentage was 40.1 %, a 36.9 % reduction (p\0.001). In the mITT analysis, there was a 22.7 % overall reduction from baseline (p\0.001). Medication cessation at 6 months was significantly associated with a reduction in total symptoms (p = 0.03).

In an article in 2000 in Physical Therapy, investigators found that teaching patients to do ischemic compression (pressure on Myofascial trigger points) in the neck and upper back was effective in reducing pain and sensitivity. We are gratified to see some studies showing the efficacy of physical therapy self-treatment for myofascial pain. We have found that self-treatment for patients with pelvic pain is by far the most effective treatment in reducing or resolving their symptoms. It goes without saying that self-treatment is the most cost-effective of methods, empowering to one’s self-esteem and in our experience the best therapy for dealing with the catastrophic thinking that comes out of the powerlessness of the pelvic pain patient to do anything about his/her pain.

While learning self-treatment inside and outside the pelvic floor for pelvic pain patients diagnosed with pelvic floor dysfunction, non-bacterial prostatitis, levator ani syndrome and pain related to muscle dysfunction in patients diagnosed with interstitial cystitis and other muscle based pelvic pain diagnoses has huge advantages in the physical and psychological dimensions of pelvic floor dysfunction, it requires careful and competent training.  Over the period of our 6-day clinic we teach patients to use the theracane, a tennis or lacrosse ball, their fingers and hands to do trigger point release abdominally, in the area of quadratus lumborum, adductors, obliques, and abdominals.  We also teach them with their fingers and our newly FDA approved internal trigger point wand to do internal trigger point release.  These are skills that can be learned and can be done with more and more skill over months of doing these skills but the initial training has to be competent.

Below is the 2000 study on teaching patients how to do the trigger point release themselves on areas of pain in their neck and upper back.

Ischemic Pressure Followed by Sustained Stretch for Treatment of Myofascial Trigger Points

Abstract

Background and Purpose. Myofascial trigger points (TPs) are found among patients who have neck and upper back pain. The purpose of this study was to determine the effectiveness of a home program of ischemic pressure followed by sustained stretching for the treatment of myofascial TPs.

Subjects. Forty adults (17 male, 23 female), aged 23 to 58 years (X?=30.6, SD=9.3), with one or more TPs in the neck or upper back participated in this study.

Methods. Subjects were randomly divided into 2 groups receiving a 5-day home program of either ischemic pressure followed by general sustained stretching of the neck and upper back musculature or a control treatment of active range of motion. Measurements were obtained before the subjects received the home program instruction and on the third day after they discontinued treatment. Trigger point sensitivity was measured with a pressure algometer as pressure pain threshold (PPT). Average pain intensity for a 24-hour period was scored on a visual analog scale (VAS). Subjects also reported the percentage of time in pain over a 24-hour period. A multivariate analysis of covariance, with the pretests as the covariates, was performed and followed by 3 analyses of covariance, 1 for each variable.

Results. Differences were found between the treatment and control groups for VAS scores and PPT. No difference was found between the groups for the percentage of time in pain.

Conclusion and Discussion. A home program, consisting of ischemic pressure and sustained stretching, was shown to be effective in reducing TP sensitivity and pain intensity in individuals with neck and upper back pain. The results of this study indicate that clinicians can treat myofascial TPs through monitoring of a home program of ischemic pressure and stretching.

1. William P Hanten,
2. Sharon L Olson,
3. Nicole L Butts and
4. Aimee L Nowicki

Author Affiliations

1. WP Hanten, PT, EdD, is Professor, School of Physical Therapy, Texas Woman’s University, 1130 MD Anderson Blvd, Houston, TX 77030 (USA) (hf_hanten@twu.edu). Address all correspondence to Dr Hanten
2. SL Olson, PT, PhD, is Associate Professor, School of Physical Therapy, Texas Woman’s University
3. NL Butts, PT, MS, is a student, School of Physical Therapy, Texas Woman’s University
4. AL Nowicki, PT, MS, is a student, School of Physical Therapy, Texas Woman’s University