Wise–Anderson Protocol

The Wise–Anderson Protocol (WAP) or Stanford Protocol (deprecated) is a treatment protocol for pelvic pain conditions in men and women, developed at Stanford University by urologists, psychologists and physical therapists. A physician does the medical evaluation and treats the medical issues, the physical therapist teaches the patients self-administered trigger point release and administers the physical therapy part of the protocol, and a psychologist treats the psychological and behavioral aspects of the relaxation protocol.^[1]

History

The protocol originated between 1995 and 2003 through a collaboration between psychologist David Wise, PhD, and Dr Rodney Anderson at Stanford University School of Medicine. Wise worked as a Visiting Research Scholar at the Stanford University Medical Center, where he treated patients with pelvic pain. Anderson was considered an international expert in the field of pelvic pain and worked as a professor at Stanford School of Medicine, as a practising urologist, and as head of the pelvic pain clinic for many years. Anderson was closely involved in research on pelvic pain with the National Institutes of Health. Together they devised the method now called the Wise–Anderson Protocol. It was initially called the Stanford Protocol but became the Wise–Anderson Protocol when the clinic moved (deliberately) outside of a hospital setting. Wise, who himself suffered chronic pelvic pain for over twenty years, cured himself using the protocol.^[2]

In 2003, Wise began an immersion treatment program in Sonoma County, California after he left Stanford. The WAP is a group process in conjunction with individual physical therapy instruction in self-treatment. Wise states that "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."^[3]

Treatment

Pelvic pain syndromes, such as Category III CP/CPPS may have no initial trigger other than anxiety, often with an element of OCD, panic disorder, or other anxiety-spectrum problem.^[4][5][6][7] This is theorized to leave the pelvic area in a sensitized condition resulting in a loop of muscle tension and heightened neurological feedback (neural pain wind-up).^[8]

The WAP focusses on stretches to release overtensed muscles in the pelvic or anal area (commonly referred to as trigger points) including digital prostate massage, physical therapy to the area, and progressive relaxation therapy to reduce causative stress.^{[9][10][11][12]}

The WAP clinic is a combination of:

• Individual medical evaluations are done with physicians prior to the intensive program. The nature of the condition of the participants is evaluated and the appropriateness of the treatment protocol determined.^[13]
• Psychological therapy (paradoxical relaxation, an advancement and adaptation, specifically for pelvic pain, of a type of progressive relaxation technique developed by Edmund Jacobson during the early 20th century). A yearlong 52 lesson audio course in Paradoxical Relaxation is supplied.
• Physical therapy (trigger point release therapy on pelvic floor and abdominal muscles, and also yoga-type exercises with the aim of relaxing pelvic floor and abdominal muscles).^[10][11]
• Participants are trained to use an Internal Trigger Point Wand and patients receive a map of their trigger points and areas of restriction.^[14]

Randomised trials of myofascial therapy have shown it to be effective at alleviating symptoms.^[15][16][17]

Publications

• A Headache in the Pelvis (2003, 2005, 2007, 2008, 2010, 2012)
• Paradoxical Relaxation (2010)

See also

• Bladder pain syndrome/interstitial cystitis — a related disease.
• Myofascial Pain Syndrome
• Myofascial Release
• Neuromuscular Therapy
• Trigger Points
• Pelvic myoneuropathy (Theoretical only)

References

1. Anderson, RU.; Wise, D.; Sawyer, T.; Chan, CA. (Oct 2006). "Sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome: improvement after trigger point release and paradoxical relaxation training". J Urol. 176 (4 Pt 1): 1534–8; discussion 1538–9. doi:10.1016/j.juro.2006.06.010. PMID 16952676.
2. Anderson, RU.; Sawyer, T.; Wise, D.; Morey, A.; Nathanson, BH. (Dec 2009). "Painful myofascial trigger points and pain sites in men with chronic prostatitis/chronic pelvic pain syndrome". J Urol. 182 (6): 2753–8. doi:10.1016/j.juro.2009.08.033. PMID 19837420.
3. David Wise. "Dr David Wise Responds". chronicprostatitis.com. Retrieved 2013-06-28.
4. Anderson, RU.; Orenberg, EK.; Morey, A.; Chavez, N.; Chan, CA. (Nov 2009). "Stress induced hypothalamus-pituitary-adrenal axis responses and disturbances in psychological profiles in men with chronic prostatitis/chronic pelvic pain syndrome". J Urol. 182 (5): 2319–24. doi:10.1016/j.juro.2009.07.042. PMID 19762053.
5. Anderson, RU. (Oct 2011). "Chronic prostatitis/chronic pelvic pain: Is there a psychosocial component?". Can Urol Assoc J. 5 (5): 333–4. doi:10.5489/cuaj.11219. PMID 22031614.
6. Li, HC.; Wang, ZL.; Li, HL.; Zhang, N.; Chen, HW.; Zhang, P.; Gan, WM.; Chong, T.; Wang, ZM. (Aug 2008). "[Correlation of the prognosis of chronic prostatitis/chronic pelvic pain syndrome with psychological and other factors: a Cox regression analysis]". Zhonghua Nan Ke Xue. 14 (8): 723–7. PMID 18817346.
7. Clemens, JQ.; Brown, SO.; Calhoun, EA. (Oct 2008). "Mental health diagnoses in patients with interstitial cystitis/painful bladder syndrome and chronic prostatitis/chronic pelvic pain syndrome: a case/control study". J Urol. 180 (4): 1378–82. doi:10.1016/j.juro.2008.06.032. PMC 2569829. PMID 18707716.
8. Anderson, RU.; Wise, D.; Sawyer, T.; Chan, C. (Jul 2005). "Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men". J Urol. 174 (1): 155–60. doi:10.1097/01.ju.0000161609.31185.d5. PMID 15947608.
9. Anderson, RU.; Wise, D.; Sawyer, T.; Glowe, P.; Orenberg, EK. (Apr 2011). "6-day intensive treatment protocol for refractory chronic prostatitis/chronic pelvic pain syndrome using myofascial release and paradoxical relaxation training". J Urol. 185 (4): 1294–9. doi:10.1016/j.juro.2010.11.076. PMID 21334027.
10. Anderson RU, Wise D, Sawyer T, Chan C (2005). "Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men". J. Urol. 174 (1): 155–60. doi:10.1097/01.ju.0000161609.31185.d5. PMID 15947608.
11. Anderson RU, Wise D, Sawyer T, Chan CA (2006). "Sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome: improvement after trigger point release and paradoxical relaxation training". J. Urol. 176 (4 Pt 1): 1534–8; discussion 1538–9. doi:10.1016/j.juro.2006.06.010. PMID 16952676.
12. "The Stanford Protocol". 2005. Retrieved 2006-12-09.
13. David Wise. "Clinic Content". PelvicPainHelp.com. Retrieved 2013-06-28.
14. Anderson, R.; Wise, D.; Sawyer, T.; Nathanson, BH. (2011). "Safety and effectiveness of an internal pelvic myofascial trigger point wand for urologic chronic pelvic pain syndrome". Clin J Pain. 27 (9): 764–8. doi:10.1097/AJP.0b013e31821dbd76. PMID 21613956.
15. FitzGerald, MP.; Anderson, RU.; Potts, J.; Payne, CK.; Peters, KM.; Clemens, JQ.; Kotarinos, R.; Fraser, L.; et al. (Aug 2009). "Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes". J Urol. 182 (2): 570–80. doi:10.1016/j.juro.2009.04.022. PMC 2872169. PMID 19535099.
16. Fitzgerald, MP.; Anderson, RU.; Potts, J.; Payne, CK.; Peters, KM.; Clemens, JQ.; Kotarinos, R.; Fraser, L.; et al. (Jan 2013). "Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes". J Urol. 189 (1 Suppl): S75–85. doi:10.1016/j.juro.2012.11.018. PMID 23234638.
17. Fitzgerald; et al. (2012). "Randomized Multicenter Clinical Trial of Myofascial Physical Therapy in Women with Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS) and Pelvic Floor Tenderness". J Urol. 187 (6): 2113–2118. doi:10.1016/j.juro.2012.01.123. PMC 3351550. PMID 22503015.

External links

• National Center for Pelvic Pain Research (WAP home page)
• The Urologic Chronic Pelvic Pain Syndrome Society