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 www.pelvicpainhelp.com, 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, www.pelvicpainhelp.com, 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:
- I had pelvic pain for over twenty years. I sit here at this moment, writing this response, free from any pain or symptoms. I have been pain free for many years. I am an example of someone with long standing pelvic pain who got better.
- I hasten to say that my most important credential relating to the treatment of pelvic pain syndromes has little to do with my being an experienced clinical psychologist. By far the best of what I have to offer is the fact that I had pelvic pain for over 20 years, and using a form of the methods that we describe in our book and teach patients in our immersion clinics, I was able to recover from pelvic pain and no longer have symptoms.
- I suffered silently for a long time as is the case with most of us who have suffered from pelvic pain. Among other symptoms, for years sitting was painful, which made my work and personal life very difficult. Sexual activity was painful and would flare up my symptoms. I had very disturbing urinary symptoms. I walked around preoccupied with the pain in my pelvis that never went away. As I got older, my symptoms became more and more intolerable and I often felt desperate. I felt alone and received little help from any treatment.
- When I was in the most pain and didn't know if it would ever stop, I was not a stranger to suicidal thoughts. As with many pelvic pain patients, pelvic pain for me was a slow motion nightmare. As I think back, I don't know what would have happened to me if I continued to be in pain. My point is that gratefully I am an example of someone who has suffered the experience of his patients and has come out the other side. No academic degree can confer this experience.
- As to my own credentials, I have been a licensed psychologist in the state of California for 37 years. My license number is PSY4050. I passed the California psychology licensing exam in 1973, after complying with all of the rigorous state requirements. I have had an enduring interest in social psychology throughout my academic and professional career. I attended the University of California Berkeley for both my undergraduate and graduate studies, graduating with a PhD in Sociology in 1971 with a dissertation exploring the social psychological aspects of largely disaffected American youth practicing Zen meditation and translating the process of meditation into the terms of psychoanalysis and western depth psychology, drawing a novel comparison of the social psychological environment of the Calvinists described in Max Weber's classic book, The Protestant Ethic and the Spirit of Capitalism, and a modern day group of largely disaffected American youth.
- My interest in social psychology has enabled me to be able to use the advantages of group process in the treatment of our current 6 day immersion clinics. I believe a combination of an individual and group treatment venue is an important contribution to the treatment of pelvic pain and other functional disorders. My interest in the psychology of meditation has helped me in understanding and explaining how to do relaxation when you are in pain.
- I estimate that I have done over 20,000 hours of psychotherapy in my psychology practice over the years. I have given continuing education courses for other psychologists at a local university. I have been a member of the American Psychological Association for as long as I have been licensed. That I have come to the area of pelvic pain as someone who recovered from it and am from a discipline outside the box of conventional urology has enabled me to view the problem from outside of the box of conventional treatment. The misleading idea put out by someone on the internet that I am a not a psychologist is nonsense and untrue.
- The understanding and knowledge that I gained in my own recovery is the most important thing I offer to the treatment of pelvic pain.
- One of the major contributions of the Wise-Anderson Protocol to the pelvic pain field is its understanding for the need of a cross disciplinary effort. While I know others disagree, it is our view that most pelvic pain is a condition involving the interaction of body and mind.
- I believe most clinicians who treat pelvic pain see the relationship between stress, anxiety and pelvic pain in most of the patients they treat. That anxiety and stress is strongly related to pelvic pain is well documented in the pelvic pain medical literature. We believe that anxiety is a major trigger and perpetuator of the condition. If you don't help a pelvic pain patient to reduce anxiety and nervous system arousal, in our view strictly physical interventions will largely be inadequate in reliably reducing or resolving symptoms in most patients. Currently there is no one subspecialty in medicine that combines the skills necessary to adequately treat the kind of pelvic pain we treat. Hence our cross disciplinary team.
- The Wise-Anderson Protocol team of practitioners consists of a physician, physical therapist and psychologist. We have integrated this cross disciplinary treatment and made it easy and seamless for patients to receive it. Our physician does the medical evaluation and treats the medical issues, our physical therapist teaches our patients self-administered trigger point release and administers the physical therapy part of our protocol, and as a psychologist, I treat the psychological and behavioral aspects of our protocol and the relaxation protocol called Paradoxical Relaxation which I have just written a book about. Members of our team all regularly talk to each other and help each other to help our patients.
- As to the setting of our program: We deliberately offer our program outside of a hospital setting. This is a clear choice we have made. I worked at Stanford University Medical Center treating patients with pelvic pain and I know what it is like to treat people in a hospital/medical environment in a cramped room with fluorescent lighting. The resort setting of our program is far more conducive to the training and healing we offer and its convenience is appreciated by our patients.
- A little about the history of my experience: Years ago, I went to see several physicians to share my new understanding of pelvic pain. Among these urologists, I had the fortune of meeting Dr. Rodney Anderson at Stanford University School of Medicine in the mid-1990s to share my experience. Dr. Anderson is considered an international expert in the field of pelvic pain and has worked as a Professor at Stanford School of Medicine, as a practicing urologist, and as head of the pelvic pain clinic for many years. Dr. Anderson has been closely involved in research on pelvic pain with the National Institutes of Health. I knew he was the man to see, to share what I had learned.
- Dr. Anderson has been a professor of Urology at Stanford University School of Medicine for many years, and while he is currently retired from full time teaching and seeing patients, he remains at Stanford University as Professor of Urology Emeritus (Active). This means he maintains an office at Stanford and can be reached there, continues to conduct research related to the Wise-Anderson Protocol, and continues to evaluate a number of patients who are interested in coming to our clinic.
- I worked together with Dr. Anderson in the Department of Urology as a Visiting Research Scholar at Stanford for eight years, treating patients with pelvic pain, developing and doing research on the method now called the Wise-Anderson Protocol.
- When I worked at Stanford with Dr. Anderson in the Urology Department, we treated individual patients with trigger point therapy and Paradoxical Relaxation in the conventional medical practice of weekly visits at Stanford University Medical Center.
- I began an immersion treatment program in Sonoma County, California after I left Stanford in 2003. Again, my interest in social psychology helped me to bring together the use of group process in treating patients with pelvic pain. It turns out that a group venue in conjunction with individual physical therapy instruction in self-treatment offers great value. In a group format, all the patients benefit from hearing the stories and questions of others. We have found that this intensive, immersion group format is the most effective way to train patients in our protocol, enabling them to treat their condition without having to rely on professional help once they leave the clinic. At the end of our clinics, without any intention on our part, the atmosphere is almost always one of a group of good friends.
- Dr. Anderson and I treated pelvic pain patients with what is now called the Wise-Anderson Protocol at Stanford University Medical Center when I was there. While Stanford is not connected with our clinics in Sonoma County, I want to be clear that we developed this protocol at Stanford where we treated prostatitis/pelvic pain patients in the Urology department. It is important to note that the protocol we currently use in Sonoma County for pelvic pain is a far improved version of the Wise-Anderson Protocol Dr. Anderson and I first used with patients when we worked together at Stanford University Medical Center.
- The research studies that we have published have all been published in the Journal of Urology. We consider this no small feat. To have even one article accepted for publication in the Journal of Urology is a significant accomplishment. Each of our articles has been peer-reviewed and scrutinized by the Journal of Urology, the most respected and prestigious of scientific urology journals in the world.
- We are among the most prolific groups in the world doing research and publishing articles on pelvic pain. Read abstracts of our research and request PDFs of the full research articles on our website.
- We have presented of our research at the National Institutes of Health and the American Urological Association among other venues. I was a plenary speaker at a National Institutes of Health scientific workshop on Prostatitis/CPPS in Washington D.C. in 2005. I presented the Wise-Anderson Protocol at the 2009 International Continence Society meetings in San Francisco.
- I recently wrote a chapter on the Wise-Anderson Protocol in "Genitourinary Pain and Inflammation," a recently published medical textbook on pelvic pain from Humana Press.
- Dr. Anderson presented a clinical poster of our work just yesterday (May 31, 2010) at the American Urological Association. Today (June 1st), a report of Dr. Anderson's presentation at the American Urological Association was published in Medscape Medical News, titled Intensive Therapy Regimen Helps Men With Chronic Pelvic Pain Syndrome.
- Dr. Anderson, Tim Sawyer and I have just completed for submission a new, updated research article detailing the results of the symptom improvement in patient symptoms in our immersion clinics in Sonoma County.
- Our group has been one of the pioneers in the treatment of prostatitis/chronic pelvic pain syndrome and non-infectious male pelvic pain. At the time we began to treat male pelvic pain in this way, there was little interest or understanding that most male pelvic pain was not prostate related but pelvic muscle related. Today many more urologists and physical therapists across the country and world are educated in and treating male pelvic pain with some components of the protocol we use. I believe our program is one of the most comprehensive that exists, bridging the gap between the different disciplines of medicine, physical therapy and psychology and empowering patients to become skilled in self treatment and free of long term professional help. There are a large number of pelvic floor physical therapists in the U.S. who understand the source of pelvic pain as a chronic contraction of the pelvic floor fed by anxiety and protective guarding.
- Many physical therapists use our book and protocol as a guideline in treating their patients and recommend our book to their patients. Recently, a National Institutes of Health multi-center study reported very encouraging results of doing physical therapy for the difficult condition of interstitial cystitis.
- We are currently in the IRB clinical trial stage for a new medical device that allows patients to reach internal pelvic floor trigger points themselves and hope to submit for publication a study of our findings regarding the device in the coming months.
- Our physical therapist, Tim Sawyer, who is the architect of our physical therapy program, was chosen to write the pelvic floor section for the new edition of Travell and Simons, Myofascial Pain and Dysfunction, The Trigger Point Manual, which is the authoritative medical textbook on myofascial trigger point therapy. Tim Sawyer trained and treated patients with Dr. Janet Travell and Dr. David Simons, the physicians who introduced trigger point therapy to medicine. Dr. Travell was the White House physician to President John F. Kennedy. Tim Sawyer is considered one of the top pelvic floor physical therapists in the world.
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.