ESWT Treatment Experience in Cornwall

[pregmom]

HI Kathy,

Do I recall you had labral tear surgery?

[kathyd]

Hi,
Sorry I just saw your post ... I have not been online for quite some time.
Yes I did have labral tear repair surgery 3yrs back on the right side..
I participated in a study my doc was doing ... the theory was that some people with vulvar/pelvic pain got relief after labral tear surgery..

So I had the surgery and also had my PSOAs muscle on the right lengthened/ (Dr Coleman did this as part of each surgery at that time.

For me it did not help ...I felt it was completely unnecessary surgery as I had never had hip pain...
I only did it as I hoped to find some relief...


I think folks who had hip issues in the first place probably would have gotten the most benefit..

Hope this helps
Kathy

[kathyd]

Hi Lernica
Just wanted to say Hi and thx for your good wishes!
I have been offline for a long time.

I did have a different experience than Faith in that I did have some relief while in Cornwall...I was able to sit a bit for a few days with much less pain..
Things changed by the time we left Canada.....long story.
But i do agree with everything Faith said and am skeptical about Dr A for some of the reasons she mentioned in her posts...

i don't think it makes sense to have to suffer so much in order to get relief..
I would love to hear from anyone who got relief and saw Dr A in the past several months (since May...) AS i still keep him in the back of my mind...

Best wishes and hugs to you too....and nice to hear fromm you Lernica!

[Lernica]

Hi Kathy,

I agree with you that hip surgery only makes sense if you have some hip symptoms such as pain, clicking, snapping, etc. I'm really sorry that it did not help you.

Did you only have the tear fixed or did they fix any bone impingement (FAI), or remove any loose cartilage pieces? Probably in the latter instances there would be pain whereas possibly in the former there might not be any pain. In my experience, most people who have scope surgeries also have multiple pathologies in their hips, not just labral tears.

Take care!

[Lernica]

Re: ESWT

Konedog just returned from Cornwall. Like you, he has experienced some initial relief but has reserved judgment on whether it will work in the long run.

[Alan1646]

In this document http://www.uroweb.org/gls/pockets/engli ... c_Pain.pdf it states on page 309: "Perineal extracorporeal shock wave therapy might be
considered for the treatment of PPS."
One of the authors of the document is Dr Baranowski.
It seems strange therefore that the treatment does not seem to be available in Europe. I can't find anyone offering it in the UK. As it specifies "perineal" can we presume that it is by definition safe for the pudendal nerve?
Edit: This is a full account of the study done using shockwave for prostate symptoms:
http://www.google.co.uk/url?sa=t&rct=j& ... u3yUa9_EDQ
Also, this Chinese study reports good outcomes, and as in the Austrian study, states there were no adverse side effects.
http://www.cmj.org/periodical/PdfList.a ... 8032502784

I wonder why there were the reports of pain/bruising for at least some of Dr Andrew's patients-do these not count as adverse side effects?

[Alan1646]

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[Lernica]

Great find, Alan! The Zimmerman study was previously posted, but this 2012 Chinese study is new and seems to validate its conclusions. The conclusion of the Chinese study is as follows (footnotes omitted):

CP/CPPS is a clinical syndrome characterized by pain in the perineum, pelvis, suprapubic area, or external genitalia, causing a variable degree of voiding and ejaculatory disturbance. Currently, the exact etiology of CP/CPPS is not completely understood, and the optimal management of CP/CPPS remains unknown. In a primary-care setting in which QOL was measured, Turner et al reported that a worse QOL was associated with greater pain and urinary symptoms, and that pain was more robustly associated with worse QOL compared to urinary symptoms. Recently, Tripp et al also reported that pain intensity and urinary symptoms were independent predictors of QOL, with pain intensity representing the strongest predictor. These findings are highly suggestive that pain relief could significantly alleviate the overall symptoms of the condition we
examined in this study, and improve the potential for effective treatment.

Over the past two decades, ESWT has been used to manage soft tissue pain in the vicinity of bone structure. The analgesic mechanisms and the specific biological effects of ESWT remain poorly understood and have not been extensively studied. Shock waves are regarded as mechanical, physical stimuli that produce extracellular cavitations when passing through human tissues. Cavitation may result in damage to local nerve endings and cell membranes; hence, the effect on transmission of pain signals. Another explanation for the analgesic effect of ESWT is the gate-control theory. Krischek et al reported that ESWT activates the small-diameter fibers and the serotonergic system, which ultimately modulates transmission through the dorsal horns.

Zimmermann et al recently reported a similar, prospective trial that included 60 patients with CPPS treated by ESWT or sham treatment in which they found reduced pain and improved QOL in a significantly greater proportion of patients who underwent ESWT treatment. In this study, we utilized similar equipment and a different treatment regimen to evaluate the efficacy and safety of ESWT in treatment of IIIB CPPS. The results were similar to Zimmermann’s study, and further demonstrated that trans-perineal ESWT significantly reduced the total NIH-CPSI, pain domain, and QOL domain compared to a control group up to a 12-week follow up time frame, which contributed greatly to the analgesic effect of ESWT. In comparison to Zimmermann’s study,18 relatively higher preliminary improvement rates of CPSI scores (68.4% in our study vs. 43.3% in Zimmermann’s study) at the 12-week follow-up after ESWT, indicating that a comparative study regarding these differences is warranted to assess the effect of the differing ESWT regimens (interval, frequency, period, etc.) in the treatment of CP/CPPS. This result supports the hypothesis that the pelvic floor muscular dysfunctions (tension myalgia) may play a prominent role in the pathophysiology of CP/CPPS. Additionally, we noted that, regardless of pain or QOL subscore, a small proportion of patients exhibited no response to treatment, indicating that an underlying mechanism causing CP/CPPS could be involved in the etiology of this disease, and that ESWT, as a single-modality treatment, has limitations.

As a new approach to treat CP/CPPS, the safety of trans-perineal ESWT is another issue that requires serious consideration. Throughout our study, fortunately, there were no adverse events or side effects reported and no anesthetic deemed necessary, similar to previous report, which further confirms the safety and ease of low energy ESWT in the treatment of soft tissue pain.

Here, again, is the link to the Chinese study: http://www.cmj.org/periodical/PDF/20121556303210.pdf

[Alan1646]

Thanks Lernica, for posting about your experience with Dr Andrew- and wonderful that it actually worked for you and others. What I don't get is why these two studies say there were no side effects/pain while Dr Andrews' treatment was so painful. Is it because he concentrates the treatment over a few days, whereas it was done over several weeks in the two studies?
Or is it that they used different equipment? I think Dr Andrew says somewhere that he now has a newer machine which causes less pain. It' s the prospect of the pain which worries me, because I can envisage traveling to Canada and then finding I can't bear to undergo the treatment.I wonder whether when / if the treatment is developed further it might be given under sedation.There are many chiroprators who use shockwave machines in the UK, but apparently only for a limited range of conditions.Still , it gives us hope that there is at least one new alternative to surgery that actually works.

Also, as shockwave therapy is now recommended as a treatment for prostate pain, treating some of the exact areas needed for PN, where is it being done in Europe? I can't find any reference to it.

[Lernica]

Dr. Andrew's treatment is painful because it is delivered in a short intensive period of time, namely 5 days, as opposed to weekly treatments spread over time. If you read Konedog's recent post you will see a detailed account of his treatment. Two hours of shockwave a day is alot more intense then 17 minutes a week, which is what I believe the Chinese study participants did.

Sorry I cannot answer your questions about European practitioners. Why don't you contact Dr. Zimmerman in Linz, Austria? He's the lead author of the 2009 study on ESWT and chronic prostatitis. Good luck!