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Response to Comments on the Internet

David Wise, Ph.D.

I have long understood that when you put yourself out in the public eye, you make yourself vulnerable to negative, misleading and untrue comments by others. In the fifteen years since we began researching and treating patients with the Wise-Anderson Protocol at Stanford University Medical Center in the Department of Urology, there has been very little of this kind of activity.  Recently, it has come to our attention that one or a few anonymous individuals have posted certain negative and misleading internet content that questions the Wise-Anderson Protocol, myself and my co-author and colleague at Stanford University, Dr. Rodney Anderson and because the internet is such a public place, I have decided to respond. I must say here that in regard to these matters, I represent no other person but myself and our group and am represented by no one else on the internet and have given no one else authority to speak or act on my behalf.

If you have read and are confused by any internet content regarding our work, you may wish to read this letter, go to our website, and read our published studies and/or our book, A Headache in the Pelvis, and then come to your own conclusions.

A personal word: I am 65 years old, an age when many people retire. I don't know how long I will continue to work but I certainly choose now to enthusiastically continue my work for the foreseeable future. Anyone who ever had long standing pelvic pain like myself, and who got better, could only want to help others out of pain.

Nearly all of the patients we see have not found help with conventional medical treatment. Most have done much research into their condition. Many know more about pelvic pain than the doctors they see. An educated, informed patient is a patient that we are most likely to help. Most of the patients who come to see us have made a clear choice, after extensive research, to learn our protocol. I believe our patients are among the most informed and educated about all of the pelvic pain treatments available.

We have documented in a peer-reviewed study (J Urol. 2005 Jul;174(1):155-60) that the large majority of our patients have an often significant reduction in pain and symptoms with our treatment protocol. While our studies have focused on men, it is our experience that women with muscle related pelvic pain respond in a very similar way.

We have treated patients who, like myself, have become completely pain and symptom free. We have treated patients who have been able to significantly reduce their symptoms and patients who have not been helped by our program although they are in the minority. There is no treatment for pelvic pain that helps everyone or promises to help everyone and no responsible clinician would claim to do so. That we have had the success we have had in treating this condition, however, is remarkable, especially considering that in recorded history, there has never been an effective treatment for it. Furthermore, it is remarkable considering the amount of home self-treatment that our protocol requires and the fact that almost all of our patients have suffered from the problem for many years and have not been helped by any other treatment.

Our protocol requires daily self-treatment for an extended period of time. It is a treatment that you have to self-administer. Just like you take care of your teeth, the patients most likely to resolve their pelvic pain that we have seen take on the responsibility for ending the chronic guarding in the muscles of the pelvic floor. Our treatment is not done to you. You do it yourself. If you don't commit yourself to doing the home program, our protocol will not work. Some people balk at these requirements. Those who do are not good candidates for our program.

There is a distinction in medicine between disorders of function and disorders of structure.  Negative and misleading comments appear to come from one or a few individuals who seem to believe that pelvic pain is a disorder of structure. The differences in opinion as to whether the kind of pelvic pain we treat (which is variously diagnosed as chronic pelvic pain, pelvic floor dysfunction, prostatitis, chronic pelvic pain syndrome, interstitial cystitis, levator syndrome, pelvic floor myalgia, pudendal neuralgia among others) is a functional or structural disorder are legitimate differences in opinion. We respect, although disagree with, those who hold the view that this kind pelvic pain is a structural disorder. The question of whether pelvic pain is a structural or functional disorder is a central question debated at the many scientific meetings in which we have participated.

In scientific meetings, and in our writings, we have been passionate advocates of our protocol that treats pelvic pain as a functional disorder. My own passion about this view comes from the fact that our protocol saved my life. In my disagreement with some approaches that involve surgery or drugs, however, I may have offended some who advocate other treatments. I am sorry if I offended anyone with the way I have expressed my disagreement over the years. The truth about how I feel is that if a method helps reduce or resolve anyone's pelvic pain, whether it agrees with my viewpoint or not, I celebrate for that person.

Getting out of pain is the primary issue. The method is secondary. The best test of a treatment for pelvic pain and its theoretical basis is whether it reduces or resolves the pain. I doubt anyone would argue with the idea that results are everything.

We see and treat pelvic pain as a disorder of the functioning of the pelvic floor, and not a pathology of its structure.  In other words, we believe that in the kind of pelvic pain we treat, the structures in and around the pelvis are normal. In the overwhelming majority of cases, it is the functioning of these structures that is problematic because of a chronic pelvic floor spasticity or hypertonicity. There may be a variation in this in IC, where an interaction between the functional disorder of pelvic floor dysfunction, and the structural issue of bladder lining inflammation or ulceration may occur and each then potentiates the other. We discuss this in our book under the subject of neurogenic inflammation.  We believe that in the vast majority of cases, if you correct the functioning and cooperation of the muscles of the pelvic floor, and restore them to a relaxed state, and thereby end a self-feeding cycle of tension, anxiety, pain and protective guarding, in most cases you reduce or resolve symptoms. We believe, at this point, that the only way to do this is with a behavioral protocol.

When I was symptomatic I tried all kinds of treatments, hoping against hope that they would help me. Nothing helped me before I addressed the chronic spasticity of my pelvic floor. Our book, the research articles we have published in the Journal of Urology or have been published about us elsewhere, the chapters we have written in medical textbooks on pelvic pain, the talks we have given at scientific meetings, the information on our website,, all discuss the efficacy of rehabilitating a chronically contracted pelvis and the nervous system arousal that perpetuates it.

We live in a peculiar time in which anyone can anonymously post anything they want on the internet about your person and your work. There is essentially no accountability. We respect that people have the right to disagree with our approach. When one or a few individuals hide behind the anonymity of the internet and resort to name calling, and deprecating our work, such behavior goes beyond disagreement and debate regarding the method. The point of this letter is to address the recent internet content that goes beyond disagreeing with our approach into the realm of misleading and untrue statements, personal attacks and conspiracy.

Here are the facts:

All of us involved in the Wise-Anderson Protocol remain greatly enthusiastic about our work and grateful that we are able to help many patients who suffer from pelvic pain to significantly reduce or resolve their pain. We believe our new medical device is going to be a game-changer in allowing pelvic pain patients to treat all internal trigger points themselves.

I hope this letter will be helpful in providing relevant information so that those with pelvic pain faced with often conflicting information on the internet may draw their own conclusions about our work. We encourage pelvic pain patients to research all of their options and make an informed and thoughtful decision about which treatment protocol to pursue.