When it comes to chronic pelvic pain, you need an “A-Team”. There’s no doubt about it. This is important as both the patient and the healthcare provider.
Moreso, utilizing this A-Team simultaneously is important. Let’s take a moment to note the difference between a “multidisciplinary” team and an “intradisciplinary” team. A “multidisciplinary” team refers to multiple disciplines that are working parallel to each other, but not interacting, not communicating, not working together. An “intradisciplinary” team refers to multiple disciplines working and communicating together throughout the duration of the treatment plan. The latter is what I’m talking about as your “A-team”.
Your neuromuscular system will respond faster when you experience multiple modalities at the same time – ideally speaking the same “language” and on the same page. All treatments improve the efficacy of the other when the approach is collaborative in nature.
It’s stressful when you’re receiving different diagnoses and different approaches and different recommendations. It’s challenging to both patient and provider when this happens, because we don’t want to disrespect the other specialist and we all want what’s best for the patient. This is why understanding the anatomy and physiology of pain, stress, and trauma, and the interaction between them (ie. The study of “psychoneuroimmunology”) is so important for anyone who treats chronic pain, let alone chronic pelvic pain.
With any type of chronic pain, an “A-team” offering an intradisciplinary approach is necessary for optimal and sustainable healing and recovery. The simultaneous aspect of the treatments and how they interact and benefit each other is important to understand. For example, you want to improve your sleep and practice the vagus nerve retraining techniques I teach in my book while practicing your pelvic floor physical therapy exercises while decreasing systemic inflammation via diet changes, various supplements, increased water intake.
Furthermore, if you are doing all of the above while receiving nerve blocks or other injections that Pelvic Rehabilitation Medicine offers, your body will respond with more grace and efficient healing. We also see this is true if you require surgery for endometriosis or other invasive surgical or diagnostic procedures. Yes, I’m biased because I teach the brain retraining techniques. Nevertheless, the evidence-based literature is clear and certain that a nervous system that is calm has decreased inflammation and responds better to any procedures, i.e. less pain, less inflammation, and quicker recovery times.
Let’s think about an example. If you are needing a surgery for endometriosis to remove adhesions and scar tissue, and active endo tissue, you’re most likely already in a lot of pain, which increases the stress response, and therefore increases the pace at which endo tissue can grow. If you don’t know how to down regulate your nervous system, and you’re coping with eating lots of sugar, carbs, caffeine, and you’re curled up on the couch most of the day, you will be going into that surgery with higher inflammation, higher pelvic floor tonicity (tighter muscles in the pelvis) and have significantly more pain and inflammation following the surgery as well as a longer recovery time. Let’s be sure to mention that if you were doing the A-team approach, you may realize you don’t need a surgery at all! Wouldn’t that be great?
I’m not saying that you can always avoid endo surgery with intradisciplinary techniques – but – you also don’t need multiple surgeries and multiple laparoscopies throughout your life either. Let’s work together to minimize the physical trauma on the body from these procedures and improve your quality of life overall!
This week and next, I am THRILLED to spend a week with my “A-team” providers at the International Pelvic Pain Society conference in Orlando, FL and will be visiting the incredible team at Pelvic Rehabilitation Medicine’s headquarters in West Palm Beach!
At the IPPS conference, I feel exhilarated to be surrounded by incredible spirits that share my passion, dedication, and fascination with the scientific study of chronic pelvic pain and associated dysfunctions. It feels like the beginning of world peace (not really exaggerating if you understand the normal politics between medical fields) when I am in a room of so many different specialities respecting each other, talking to each other, listening to each other, and working together to improve their knowledge, understanding, and practice in how to assess, diagnose, and treat patients with chronic pelvic and sexual pain disorders.
It’s not too late to register for the Clinical Foundations Training Course that I have Chaired for over 3 years!
This pre-conference day-long training is an extensive overview of how “it’s all connected” and how providers can work together for the benefit of themselves and their patients. We know that providers working together decreases burnout and improves patient outcomes. This year’s main conference is the 25th Anniversary of IPPS! So we’re going to be having a marvelous time with expert panels, entertaining research reviews, and not to mention the Friday night Fundraiser Karaoke party! Finally, join us at the post-conference for a deep-dive into the pelvic floor physical therapy realm of chronic pelvic pain and learn from the best experts in the field on tried-and-true techniques that even therapists like myself could benefit from knowing and understanding. For example, since I’ve gone to over 10 IPPS conferences, my knowledge allows me to create meditative recordings that guide patients through the exercises they’ve been instructed to do by their pelvic floor PT. This can help remind the patient to breathe, relax, and visualize the change they want to experience through the exercises they’re doing. It’s one of the many simple and effective ways behavioral health specialists can be supportive of the other modalities. I hope you can join me at the IPPS conference! Register today at www.pelvicpain.org.
In summary, here is a list the best specialties to have on your “A” team, followed by a brief description of some of the treatments they can offer. A book could be written on every specialty! If I’m aware of a book by a specialist, I include it in the description.
Ideally offers: mindfulness, hypnosis, neurolinguistic programming, and autonomic nervous system regulation through somatic therapies and breath work
Book recommendation: Healing Painful Sex by Deborah Coady, MD, and Nancy Fish, LCSW
Acupuncture and Chinese medicine
Ideally offers: acupuncture, laser and light therapy, herbal remedies, homeopathy, and kinesiology (muscle testing) for Lyme, parasites, and other GI and immune disorders that may not be identified using Western Medicine tests
Book recommendation: The Essential Companion and Study Guide of Chinese Herbal Medicine by Lisa Pilar Baas (lisabaashealingarts.com)
Yoga, Qi Gong, and Tai Chi
Ideally offers: gentle, mindful movement exercises that strengthen the posture muscles
Ideally offers: singing bowls, tuning forks, gongs, and other vibrational healing techniques
Book recommendation: Sound Healing by Mitchell Gaynor, MD
Ideally offers: evaluation of whole-body movement and function, joint inflammation, nerve blocks and other injections that can help heal the nerves in the hips and pelvis
Book recommendation: Chronic Pelvic Pain and Pelvic Dysfunctions: Assessment and Multidisciplinary Approach edited by Alessandro Giammo and Antonella Biroli
Ideally offers: holistic approach to evaluating the whole body and whole self
Book recommendation: Solving the Autoimmune Puzzle by Keesha Ewers, MD
Pelvic floor physical therapy
Ideally offers: physical therapy to rehab the lower back, pelvis, hips, abdomen, diaphragm, posture correction, and whole-body balancing to relax and release the tension and spasms in the pelvic floor muscles
Book recommendations: Heal Pelvic Pain by Amy Stein; Mary Velicki’s three-book healing series; Pelvic Pain Explained by Stephanie Prendergast
Ideally offers: evaluation of reproductive organs; rule out inflammatory and disease processes including endometriosis and fibroids
Book recommendations: Healing Painful Sex by Deborah Coady, MD, and Nancy Fish, LCSW; Silent Suffering by Robert Echenberg, MD, and Susan Bilheimer
Ideally offers: support for anti-inflammatory diet, food substitutions and recipes, health coaching and support for healthy lifestyle changes
Book recommendations: any books by Jessica Drummond; nutrition courses by Monique Bogni at Pelvic Rehabilitation Medicine
Ideally offers: evaluation of gastrointestinal system, organ health and functional evaluation, rule out inflammatory and disease processes
Ideally offers: evaluation of bladder, kidneys, and prostate; rule out inflammatory and disease processes
Book recommendation: Headache in the Pelvis by David Wise, MD