Success Rate of the Stanford/Wise-Anderson Protocol
Posted: Thu Jun 17, 2004 6:48 pm
In reply to a question about the success rate of the Stanford/Wise-Anderson Protocol, David Wise wrote:
David Wise wrote:Dear Mark,
While we often hear from patients as to how they are doing, we have had no support or resources to prospectively and systematically collect data on outcomes of patients that we treat. Simply seeing patients who are in pain in a busy clinical practice has allowed for little else. Recently we have become part of an 11-center study to evaluate treatments for pelvic pain sponsored by the National Institutes of Health (NIH). Our involvement in this NIH consortium should accommodate the prospective and scientifically vigorous evaluation of the efficacy of our protocol if indeed NIH gives approval for our specific protocol. In the interim, a retrospective analysis of approximately 150 patients treated at Stanford at various points in the development of our protocol is underway and should give us insights into improvement in quality of life associated with the decrease in pain symptoms.
Patients who have done well with our protocol have been more likely to have had pain for a long time and seem to have intuitively understood that their condition was not like a broken bone or a simple infection cured by antibiotics. They were open to what we offered them. These folks tended to have trigger points, which, upon palpation, in some way duplicated their symptoms. Furthermore, these patients demonstrated a very strong motivation witnessed by their full compliance with our protocol. Recently, I think we have seen better results with people who have read our book and who understand more fully the requirements of treatment.
The results of our treatment were less satisfactory in patients who did not have trigger points that reproduced their symptoms upon palpation, and/or if they were not willing to devote themselves to our protocol. However, some people who had very tight pelvic muscles did well even though they did not have specific trigger points that reproduced their symptoms.
There are other factors that seem to interfere with a good understanding of the results of our treatment. The use of narcotic medications may reduce the efficacy of our approach although we have had a few patients who have done well and continue to do well after having withdrawn from the narcotic medications. For those patients with other physical or psychological problems such as fibromyalgia, cancer, chronic fatigue syndrome, neurourologic disorders, schizophrenia and other psychotic disorders, injury to the spine, and pelvic related surgeries and procedures, our approach can still be helpful but the general efficacy is often, (though not always) mitigated.
Thus, the question of the efficacy is not a simple issue, as there are many factors associated with the resolution of pelvic pain. To summarize however, when there is no gross pathology, patients with typical CPPS symptoms in whom we can reproduce symptoms by palpating trigger points who are motivated to do whatever it takes, have the best results from our treatment.
Our approach has evolved over the past 10 years. I believe that the format of a 6-day intensive clinic or an intensive 5-6 day individual program is the very best format for teaching our method as it provides sufficient time for people to learn the home treatment. We also teach partners of patients how to do the myofascial trigger point release and this works quite well. From my observations, the least effective form of treatment delivery has been one in which patients are seen in a few brief office visits when only a small amount of time can be devoted to instruction in home treatment which is the core of our approach.
When we first thought about writing A Headache in the Pelvis, we discussed whether we should wait until a report of a prospective study of our protocol was completed before we wrote our book. We certainly could have waited. At that time, however, we had no assurance if and when we would ever receive any funding for such a study. Furthermore I knew that I personally would have been very grateful for a book like A Headache in the Pelvis when I was symptomatic, whether or not there were conclusive studies done on it or not. I felt confident that most other sufferers would feel the same way as I did. So we published the book.
Let me talk a little bit about "cure." Cure implies that you have a problem that a treatment simply eradicates. I do not think that the successful resolution of chronic pelvic pain syndromes means that they can never flare up. There was a time when sitting when I was out to dinner or at movie was agonizing, and driving my car even a little way, required that I sit inclined on one buttock. With gratitude, I sit here comfortably writing this letter without any pain. I do not however describe myself as being cured. I do relaxation every day and do my best to live a life in which I am not swept up in anxiety and a type A lifestyle. I believe that if I stopped doing relaxation, and went back to an unconscious, "˜burning the candle at both ends' lifestyle, which is my predilection, my pain would probably return. If I did have a flare-up, however, I would not consider it a bad thing or a failure but simply a wake up call to do what I needed to do to return to balance without symptoms.
In my view, sooner or later most people have their version of chronic pelvic pain syndrome, be it irritable bowel syndrome, constipation, anxiety disorder, low back pain, non-cardiac chest pain, headache, temperomandibular disorder or hypertension. The body is fragile. Different bodies respond to age and stress at different sites in the body. People with the kind of pelvic pain we treat happen to be pelvic responders. The point, in my view, is to understand how to live a life that quiets down or eliminates the symptoms. For a certain group of people with pelvic pain of the kind that we successfully treat, I believe there may be no permanent cure, only daily treatment of becoming inwardly quiet that keeps one essentially symptom free. The point is to be able to effectively deal with the tendency to tighten up the pelvis so that it does not interfere with your life and happiness.
David Wise, Ph.D.