Doubtful benefits of physical therapy

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Doubtful benefits of physical therapy

Postby Alan1646 » Thu Mar 05, 2015 8:31 pm

On my pain management course we were told by Physiotherapists that hands on treatment was of little benefit.
See slide nine:
http://pelvicpain-meeting.com/wp-conten ... ughlin.pdf
Last edited by Alan1646 on Thu Mar 12, 2015 10:35 am, edited 1 time in total.
"if you want to keep a secret you must also hide it from yourself" Orwell
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Re: Doubtful benefits of physical therapy

Postby nyt » Sat Mar 07, 2015 4:36 pm

What do they mean by "Passive" hands on? I'm not sure the difference between a PT who uses "passive" versus "active" hands on. I'm familiar with the publications by Dr. Wise. Did they reference any of his work as it is quite sound the improvements in pelvic pain some individuals have? Nothing is ever 100% effective for every individual so I would never expect that in a peer reviewed journal publication that all patients treated would see improvement, it I did I would be suspicious of the research.

The other slides talk about a multidisciplinary approach with PT being part of that team. If I understand the slides correctly their role seems to be more in education as part of a CBT and maybe some stretches. Do I understand that correctly?
2/07 LAVH and TOT 7/07 TOT right side removed 9/07 IL, IH and GN neuropathy 11/07 PN - Dr. Howard
6/08 Obturator neuralgia - Dr. Conway 11/08 Disability, piriformis syndrome - Dr. Howard
4/09 Bilateral obturator decompression surgery, BLL RSD - Dr. Howard
9/10 Removed left side TOT, botox, re-evaluate obturator nerve - Dr. Hibner
2/11 LFCN and saphenous neuralgia - Dr. Dellon 2/11 MRI with Dr. Potter - confirmed entrapment
5/11 Right side TG - Dr. Hibner 2012 Left side TG - Dr. Hibner
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Re: Doubtful benefits of physical therapy

Postby ezer » Sat Mar 07, 2015 5:45 pm

The Wise study was very inconclusive if you look into the details.
It is interesting that no other study was performed after that one. The abstract conveniently fails to disclose the most important point which is that the patients had a median reduction in pain from a 4/10 to a 3/10 in 6 months. It is then mentioned that the improvement was sustained after 2 years. In other words the Wise Anderson protocol improved those people by only 1 point on the VAS pain scale and subsequently there was no more improvement.
Also mysteriously, 40% of the patients were dropped throughout the study.
2002 PN pain started following a fall on a wet marble floor
2004 Headache in the pelvis clinic. Diagnosed with PNE by Drs. Jerome Weiss, Stephen Mann, and Rodney Anderson
2004-2007 PT, Botox, diagnosed with PNE by Dr. Sheldon Jordan
2010 MRN and 3T MRI showing PNE. Diagnosed with PNE by Dr. Aaron Filler. 2 failed PNE surgeries.
2011-2012 Horrific PN pain.
2013 Experimented with various Mind-body modalities
3/2014 Significantly better
11/2014 Cured. No pain whatsoever since
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Re: Doubtful benefits of physical therapy

Postby Alan1646 » Sat Mar 07, 2015 7:42 pm

nyt wrote:What do they mean by "Passive" hands on? I'm not sure the difference between a PT who uses "passive" versus "active" hands on. I'm familiar with the publications by Dr. Wise. Did they reference any of his work as it is quite sound the improvements in pelvic pain some individuals have? Nothing is ever 100% effective for every individual so I would never expect that in a peer reviewed journal publication that all patients treated would see improvement, it I did I would be suspicious of the research.

The other slides talk about a multidisciplinary approach with PT being part of that team. If I understand the slides correctly their role seems to be more in education as part of a CBT and maybe some stretches. Do I understand that correctly?


UCLH state that they are world leaders in clinical research, so I think they can be trusted when they say that they have reviewed the evidence and research into this type of therapy for pelvic pain.
By passive I think they are referring to the patient rather than the therapist.They encouraged us to be active in a number of ways,physically and mentally.
I leave it up to you to decide for yourself whether the available statistics mean that Dr Wise's publications can be regarded as high quality evidence.
On the course, there were contributions from several pain consultants at the hospital who gave presentations and answered questions about medication and lifestyle modifications, theoretical sessions about pain, physio,with various exercises and stretching ,but as I said, no hands on massage ,meditation techniques and sessions,input from clinical psychologists and CBT techniques.It was free,on the NHS.
Ezer makes some thought provoking comments on Dr Wise's research statistics.
"if you want to keep a secret you must also hide it from yourself" Orwell
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Re: Doubtful benefits of physical therapy

Postby nyt » Sun Mar 08, 2015 6:28 pm

I just spent an hour pulling literature sources if anyone wanted to look up publications for themselves but lost my post :twisted: . I will try and do this again over the next day or two.

In general, if you find internal massage helps you, fantastic, if not, move on to another therapy. Not all therapies nor modalities work for everyone. I am not willing to through the baby out with the bath water.

I'll post the references later.
2/07 LAVH and TOT 7/07 TOT right side removed 9/07 IL, IH and GN neuropathy 11/07 PN - Dr. Howard
6/08 Obturator neuralgia - Dr. Conway 11/08 Disability, piriformis syndrome - Dr. Howard
4/09 Bilateral obturator decompression surgery, BLL RSD - Dr. Howard
9/10 Removed left side TOT, botox, re-evaluate obturator nerve - Dr. Hibner
2/11 LFCN and saphenous neuralgia - Dr. Dellon 2/11 MRI with Dr. Potter - confirmed entrapment
5/11 Right side TG - Dr. Hibner 2012 Left side TG - Dr. Hibner
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Re: Doubtful benefits of physical therapy

Postby Ray P. » Mon Mar 09, 2015 2:34 am

I had PT from different PT that specialized in PNE.
All of it never helped one bit.

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Re: Doubtful benefits of physical therapy

Postby cpps-admin » Sat Mar 14, 2015 12:55 am

ezer wrote:The Wise study was very inconclusive if you look into the details. It is interesting that no other study was performed after that one. The abstract conveniently fails to disclose the most important point which is that the patients had a median reduction in pain from a 4/10 to a 3/10 in 6 months. It is then mentioned that the improvement was sustained after 2 years. In other words the Wise Anderson protocol improved those people by only 1 point on the VAS pain scale and subsequently there was no more improvement. Also mysteriously, 40% of the patients were dropped throughout the study.


I don't post here anymore, but feel I must on this one. Ezer, that's an inaccurate assessment of the effectiveness of the Wise Anderson Protocol.

A new study is out last month, showing the actual effectiveness after short followup. Note that 6 months is actually a very short followup period for a chronic pain syndrome. I cured myself completely using similar techniques, but it took several years. Bear that in mind; what you are seeing here at 6 months are people in the process of being cured

Appl Psychophysiol Biofeedback. 2015 Feb 24. [Epub ahead of print]
Chronic Pelvic Pain Syndrome: Reduction of Medication Use After Pelvic Floor Physical Therapy with an Internal Myofascial Trigger Point Wand.
Anderson RU1, Harvey RH, Wise D, Nevin Smith J, Nathanson BH, Sawyer T.

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 in medication 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).

PMID: 25708131
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Re: Doubtful benefits of physical therapy

Postby ezer » Sat Mar 14, 2015 3:02 am

Yeah sure whatever. We see so many PT success stories here.
My many PT sessions (2004-2006) with your beloved Tim Sawyer made absolutely no difference.

Here is the quote from the Wise-Anderson study. I am not inaccurate at all:

http://www.thedoctorschannel.com/view/i ... -cpcpps-2/

J Urol 2011;185:1294-1299
Median pain score measured with a visual analog scale decreased from 4 (out of 10) to 3 at follow-up, ... Improvements were sustained in patients with a long-term follow-up of 23 months.


Pain being the main source of complaint for people like us, 1 point of median pain improvement is extremely disappointing but it sadly matches what so many of us have experienced. The Wise Anderson protocol is a time consuming pain management but it does not "heal" you and certainly does not make you asymptomatic (pain free).
Also worth noting is that the study retained 116 people out of 200. What happened to the 84 people that were dropped from the study...?????
2002 PN pain started following a fall on a wet marble floor
2004 Headache in the pelvis clinic. Diagnosed with PNE by Drs. Jerome Weiss, Stephen Mann, and Rodney Anderson
2004-2007 PT, Botox, diagnosed with PNE by Dr. Sheldon Jordan
2010 MRN and 3T MRI showing PNE. Diagnosed with PNE by Dr. Aaron Filler. 2 failed PNE surgeries.
2011-2012 Horrific PN pain.
2013 Experimented with various Mind-body modalities
3/2014 Significantly better
11/2014 Cured. No pain whatsoever since
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Re: Doubtful benefits of physical therapy

Postby cpps-admin » Sat Mar 14, 2015 11:54 am

Mr Ezer, I'm sorry to disagree with you, but you do not appear to know what you are talking about. You repeatedly complain that the VAS Pain score only decreased from 4 to 3. Do you know what the VAS Pain score is? It's a visual way for people to score pain, using the diagram below:

Image

So going down one grade on that scale is very significant, especially after only 6 months, given that we know this is a chronic pain condition that does not get cured overnight, and where patients have sometimes spent decades without any significant relief.

In addition, more subtle measures of pain and urinary dysfunction from that study (which can be read here in full) tell a more nuanced story:

painscores.png
painscores.png (9.81 KiB) Viewed 1705 times


These score changes are not insignificant (I use the word in the statistical sense as well). CP/CPPS is very intransigent condition, and these patients had failed numerous other treatments.

What happened to the 84 people that were dropped from the study...?????


They were sent questionnaires but did not respond. That's pretty typical for such post-treatment questionnaires. A study done in 2000, "Assessing research outcomes by postal questionnaire with telephone follow-up", found that "Response to the initial posting was 60%", which is close to the result obtained here too (116/200 = 58%). So once again, you are casting aspersions from a position of ignorance about how research works.

Now it is clear some patients, such as you, are complete non-responders. There are many treatment modalities in medicine that do not help a certain percentage of patients. But it is extremely unfair and unwise for those patients who are not helped to stand on soapboxes and tell all other potential patients that they won't be helped too. :roll:
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Re: Doubtful benefits of physical therapy

Postby Alan1646 » Sat Mar 14, 2015 1:45 pm

Yes,the last study you quoted does say the initial response rate was 60%, but it goes on to say that the response rate rose to 85% after reminders.Did the Wise Anderson study include reminders?
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