AUA 2010 - Wise-Anderson Protocol

[webslave]

JOURNAL OF UROLOGY, Volume 183, Issue 4, Supplement, Pages e310-e311 (April 2010)


6-Day Intensive Physiotherapy And Cognitive Behavior Clinic Treatment For Chronic Prostatitis/Chronic Pelvic Pain Syndrome

Rodney Anderson* (a), David Wise (b), Tim Sawyer (b), Patricia Glowe (a)

INTRODUCTION AND OBJECTIVES

Treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) remains elusive. For patients exhibiting the phenotype of pelvic musculature tenderness, manual physiotherapy and cognitive behavior relaxation training appears to be helpful. The objective of this study was to show outcome benefits of an intensive 6-day immersion clinic in treating severely refractory patients.

METHODS

Men referred for treatment underwent physical examination, answered pain symptom questionnaires, and then spent several hours per day for 6 consecutive days undergoing myofascial trigger point release and training in paradoxical relaxation. Many patients were taught how to perform their own manipulations. Follow-up symptom scores, psychological status (5-point survey of feelings about disorder and coping with their symptoms) and global response assessments were performed from 3 to 42 months after the training/treatment program.

RESULTS

We analyzed 125 men who underwent the intensive therapy regimen. Their average age was 49 years (range 20-80); pelvic pain symptom duration average was 7.7±7.8 years with a median of 4.25 years. Follow-up of outcomes occurred after an average 11.8 ± 10.5 month with a median of 7 months. Differences in NIH-Chronic Prostatitis Symptom Index (CPSI) total and domain scores before and after treatment (paired t test) are presented in the Table. Fifty-two percent of the patients self-reported moderate or marked improvements in symptoms on the global response assessment; 14 (11%) indicated no change in their symptoms. Overall psychological benefits averaged 14.2 ± 4.9 (out of maximum score of 21); 25% of patients were exceedingly positive. Sixty-seven percent of patients indicated they continue to utilize cognitive training tapes and 47% continue physical therapy. Of the men completing the therapy, 68% perceived benefit and stated they would participate again or recommend this therapy to a friend.

cpsi-scores-anderson.png (8.56 KiB) Viewed 529 times

CONCLUSIONS

CP/CPPS patients with long-standing pain, which is refractory to traditional treatment, may benefit from focused myofascial trigger point therapy and cognitive behavior relaxation training. Refinement of phenotyping and selection of patients should enhance the success rate with this treatment modality.

(a) Stanford, CA
(b) Sebastapol, CA

Source of Funding: None

PII: S0022-5347(10)01726-X

doi:10.1016/j.juro.2010.02.1470

[webslave]

It's worth noting that these men had long-standing cases and therefore had clearly failed a lot of prior treatments. You, dear reader, may not be in this hard-core group, and you may have an even greater chance of benefiting.

That fact that nearly ¾ of them would recommend the treatment to others, when surveyed after 7 months, is remarkable.

Note that Wise himself took a couple of years to achieve a cure when attempting this treatment, so it's not surprising that quite a few of the men surveyed after 7 months did not have complete cures yet. But they were mostly improved and making progress, which is why most of them gave it a thumbs up.

Why do some cases fail completely (10%)? I don't know, but let me speculate ...

1. Inability to relax the pelvic floor. I suspect that for many men, the discipline required to stop habitual clenching of the pelvis, especially if one has a sitting job where periods of high concentration are required, is too much.
2. Undiscovered allergies or intolerances. As I've stated many times on this forum, gluten can give me pelvic pain.

Why do you think some cases fail?

[Sherradin]

Webslave

I think you're right about the sitting.

My job is now sitting all day. ON the days I get out to yoga or stretch at lunch I get less pain and use less meds. I get up as much as I can and relax the pelvic floor but it requires commitment.

Its no different for me to the men. But I watched Dr Wise sit and talk to us for a whole week at the course and he had NO pain now so I believe over the long term you still can get there.

I sit at work on a donut cushion..meetings with hard chairs wipe me out!

[davioj]

I would like to read the full paper when its ready but so far, although I am a firm believer in a myofascial explanation for CPPS, I am disappointed in the very modest decrease in disease activity scores in the abstract. Always hoped they would come with fantastic data of their immersion clinics. Still feel its the right way to go but these data will not convince the medical community which is bad news for us. The other studies webslave mentioned are positive and interesting. Thanks for browsing the AUA abstracts for us webslave!

[webslave]

Yes, it would be nice if everyone was 100% after 7 months, wouldn't it? There are no easy fixes for this condition. But the Quality of Life scores were about 30% better after a half year, which, when you consider this treatment takes a couple of years for full effect, is not too bad.

Always remember that in a group of refractory patients, like the one used in this study, outcomes are never as good. And the overall averaged figures you are looking at will include some people who are 95% better, and some who are no better at all (for any number of reasons, including non-compliance).

I also hear that a new study is in process with better outcomes. Stay tuned.

[gmccormack]

Well I am disappointed too, although, I do agree with the reasons Webslave puts forth. The truth is out of the 16 patients at my session, by no means enough to substantiate a scientific claim these numbers match up. About half are improved and those that are improved including myself are not 100% and most seem to be hovering around 30-50% better (it has been 14 months). It is notable to be 50% recovered at my worst I would have given everything for 50% recovery. I will say that I had the condition for the shortest amount of time at the clinic (5 months at the time) I would say the average was 5 years, these guys had been through a lot, not your typical patient.

To comment on Webslaves question...Frankly, I think that there different etiology's at play, maybe 70% suffer from muscular dysfunction, maybe 10% hormonal, 10% genetic precurser, 10% mixed bag (urethra stricture, blocked ejaculatory duct, etc) Certainly could be more or less in the different categories.

Shoskes IS right in his "rules" of CPPS that he released with the intention of hitting PCPs and uro's, just because it hurts somewhere in the area "from nipples to the knees does not make it prostatitis/CPPS"

In the future and I know science is working toward subsetting, ways to identify which patient will benefit from what, individualized treatment is what you will see in the coming years, patients will demand it not only for CPPS.

But in the end many including longtime members Carl, Webslave, Sleeper Service, even Shoskes, I can go on... have said that in time most patients get better. Pontari said at the AUA in 2009 that what he sees is that over months and years the patient usually starts to have more time in between flares and the flares are less severe.

back to the study...maybe it's time in most cases that results in marked improvement, these hardcore patients aren't the group that I would like to see how they are doing in another 2 years, but it would be meaningful data.

There will be other treatments in the future and maybe some that add to the WA protocol, maybe a protein manipulator that stops pain signals there are endless ideas. The resolution maybe achieved by time, PT, and relaxation but no doubt we need more science to back up this method AND other treatments for the present sufferings while we go through the "slow fix"

[webslave]

I think part of the problem with curing this condition is that nerves are involved. Conditions that involve nerves are notoriously slow to heal, so that what one looks for, optimally, is a stratagem that improves the condition incrementally, while allowing the nerves to take their own sweet time returning to a condition of homeostasis. This protocol seems to be doing that. Essentially, the goal is to relax the pelvic floor in whatever ways possible (mind control, manipulation, anesthetization) and so give the nerves a "time out" to allow them to reset. The reset is the unpredictable part, and the longer you've had this, the more fixed the abnormal (ie over-goosed) pathways have become. It's back to the analogy of allowing the grass to grow back over the unwanted pathway by not walking down that pathway all the time.