ESWT Treatment Experience in Cornwall

[Faith]

deBBieW,

It's hard to know how Dr. A treats local patients since none of them post on the forums. In some ways it would be easier, but the treatment is so aggressive I think even one treatment would leave me knocked down until the next treatment so it would just keep building and building. Really nothing comepares to the pain induced by the treatments. I felt like my body had been so badly beaten up when I left each night. I would walk like I had a corn cob up my rear and I was barely able to walk to the car. But perhaps my case is worse/more involved than others, thus my response was worse.

It's so hard to know if the tight muscles is causing the pain or if the muscles are tight in response to the pain. This is my big question. It makes treating it difficult to know how to treat it.

[Skylar]

My impresson from Dr. A was exactly as you say Faith, the longer they extend the treatment time the worse the patient's experience. It was explained to me when I suggested breaking up the appts that it would only make the pain response worse. So I don't think it is much different for his local patients.

What's key seems to be differentiating each patient's case and how important it is to treat each one according to their own tolerance, in my humble opinion. I have super sensitivities to even conservative treatments and doubt if I could tolerate even one day of ESWT/ART treatments either. It's so hard to unravel a vicious pain cycle and I do hope your situation improves soon.

And I have to say that I haven't stopped chuckling yet about your corn cob comparison. I know that exact painful feeling......your description wasn't corny at all....

All the best,
Fall Girl

[Jax87]

Have you seen Dr. A FallGirl? Just curious for my future reference when I am done with hip stuff

[Skylar]

Have corresponded with him by email and phone. It was his recommendation that I investigate the hip tears before any ESWT treatments. Good luck with your pursuits.

[Jax87]

Thanks

[Violet M]

Faith, I am really sorry to hear that ESWT/ART did not work for you. Like you, I believe that my problems are due to lax ligaments/ligament strain and pelvic instability. I am not sure what the mechanism would be for ART and ESWT to fix that type of a problem because I don't know that much about them but I think you are smart to follow your instincts and avoid further treatment if it's making you worse. If there was some sort of mechanism that Dr. A. could describe that made sense as to how it would work for someone with your issues then I could see pursuing it further but without such a description I can see why you would be reticent to pursue further treatments. Thanks for posting your story. I hope you will find some solutions soon.

Take care,

Violet

[Faith]

I forgot to mention that Dr. Andrew said I had genitofemoral nerve copression as well due to some referred pain I got when he did ART on my pectineus muscle. I'm not sure I agree with this as I never had pain in that area prior to Cornwall. But now I am starting to wonder if I do have genitofemoral entrapment or possbily only the femoral branch as my burning seems to be more in that area.

This article http://emedicine.medscape.com/article/1234809-overviewsays that [genitofemoral nerve] " Injury may also result from intrapelvic trauma to the posterior abdominal wall". And Dr. Fred Howard's book Pelvic Pain: Diagnosis and Management says that genitofemoral neuralgia can result due to lower [abdominal] quadrant blunt trauma which usually entraps small branches and twigs of this nerve.http://tinyurl.com/95xqkky

This article also has some good diagrams that others with groin pain might benefit from http://bjsportmed.com/content/43/3/213. ... s;43/3/213. My burning pain is in the upper portion of the "femoral/groin triangle" and is mostly burning in quality and my muscles are very tight.

I can not say for sure that Dr. Andrew's treatment caused damage to this nerve, of course, but I would say that his treatment was brutal enough to be trauma (as it caused many bruises and hematomas). It is also possible that someone my inguinal ligament was injured/strained and muscular trigger points resulted which are now compressing the nerve I suppose. Though massage just barely takes the edge off the pain.

[helenlegs 11]

So sorry to hear that this treatment hasn't worked for you faith, really sorry. You have tried and tried and seriously studied so hard to get some good answers to your particular problem. You could probably go into the 'what's wrong with my pelvis?' diagnosis business yourself now.
Unfortunately, as you know only too well, the whole thing can be just so complicated, especially when you may be prone to muscle tension build up, as you do seem to be??
At least my problems stay the same, it's just taken a few years to actually work out which nerves are affected. I think I have a complete working list now with Dr Greenslades help.
Have you tried pain coping strategies at all? I always though it a bit of a cop out as I was after the ultimate 'fix' or the next best to that but what I have read about CBT and other pain therapies has helped me somewhat.
I am going to ask to go on a course for pain management (probably be refused) but I think it is such a difficult thing to achieve, I need a bit more help than just reading a book if possible.
take care,
Helen

[drkirkandrew]

Some Updates and Announcements regarding PNSBDS Protocol:

The past several months the PNSBDS protocol has undergone some necessary changes to address some unfortunate developments and has evolved and improved based on new technology, research, and experiences (based on patient presentations). As with any treatment, techniques improve and evolve based upon experience (this is true of any current treatment method, for any condition).

1) New Technology
- Prior (old) ESWT technology was very expensive to purchase and operate. The PNSBDS protocol was utilizing the Swiss Dolorclast ESWT unit, an effective (and cutting edge at the time) unit, but incredibly expensive and very painful. Newer models (the Storz MP200) is much less expensive to purchase and operate. Furthermore, it is far less painful, and results in far less bruising.

2) Modification of Therapists
- Paramount to the technology or equipment is the operator of the equipment (in terms of skill, understanding, education, diagnostic abilities, etc). Previously, a massage therapist was associated with the PNSBDS protocol (operating the ESWT unit and handling this component of the treatment). Massage Therapists currently require 2 years of community college. Although a qualified and talented RMT, it became clear that to appropriately address the needs of PN/PNE patients, a therapist of increased formal education is required. Although many patients had success with the previous incarnation of the PNSBDS protocol, it became clear that many sub-types of the condition were not responding. The most important aspect of this switch is the communication factor- an RMT should not have been making comments regarding prognosis, and unfortunately this created contradictions and unrealistic expectations.

3) Modification of Location
- The location of the PNSBDS protocol was reluctantly performed at a clinic with a large overhead, owned and operated by a member of the treatment team. Unfortunately, if was here that the focus shifted from clinical to business demands. The treatment has returned to the original clinic where it was developed.

3) Through modification of location, therapists, and equipment, the costs associated with the therapy as dramatically lowered (standardized to $3500 CAN).

4) Addition of Numerous Additional types of Therapy
- We now have two Doctors of Naturopathic Medicine working on our team. New treatments include: Hormonal testing, IgG (allergy/sensitivity testing) (food sensitivity), Mesotherapy (similar to prolotherapy), acupuncture, Nutraceutical interventions, dietary interventions, psychological/emotional assessments, among others. This is to further improve the holistic approach to PN/PNE treatment (which is necessary to adequately treat the condition, as it is multi-factorial in terms of causes, symptom generators and systems/tissues affected).

All of these changes were deemed necessary for the continued success and future improved success of the PNSBDS protocol.

Many patients who underwent the prior version of the PNSBDS protocol have been offered free treatment for a follow-up (including free mesotherapy, free ESWT, free allergy testing, free hormonal testing, free physical therapy, free consultation with a Doctor of Naturopathy, free acupuncture, etc (all of which cost thousands of dollars). It is their decision to pursue it or not.

Even with these changes, some patients may not respond. Why do some patients not improve?

1) Continuation of exercise/stretching plan
- No treatment will ever succeed unless it addresses the biomechanical and anatomical causes, and implements strategies to prevent relapse. Due to neuroplasticity, the biomechanical factors that caused the condition will persist unless a proper maintenance program is in place. This is the case for any condition, from low back pain to carpal tunnel, not just PNE. The best therapy in the world will not prevent a relapse (or moreover, not be successful at all) unless the patient follows the prescribed therapy (including home-based maintenance) and avoids or minimizes aggravating factors.

2) Affect and beliefs about the cause of the condition:
- a preference for passive care types (medications, surgery) is associated with poorer outcomes for almost every Musculoskelatal condition. Patients who fare better are those who participate, and are involved in active care types (there is a plethora of research to support this).
- Fear-avoidance behaviour: this pertains to a patients perception of pain. This is a highly complex topic. It is important to understand the psychological/emotional aspects of pain (and how they can dramatically effect treatment effects and responses). This is a huge field, and the PNSBDS protocol is now addressing this aspect (as we have learned that a few cases that have not responded can be attributed to various degrees to behavioural responses as as result of the psycho-emotional components of pain).
- Expectations


Here is a basic introduction to understanding pain:

Is pain real? Yes, to varying degrees. Nociception is the neurological mechanism that is responsible for signals that conduct information regarding the state of various tissues, usually pertaining to some insult (chemical, physical, etc.). Certain types of fibres (C-Fibres and A-Delta Fibres) are responsible for nociception. Nociception is the objective aspect of pain.

Nociception only becomes what we experience as 'pain' much after the signals pass into the sensory cortex and are interpreted by conscious mind. This interpretation is entirely subjective, and can vary, depending on numerous variables such as: mood, past history, social and cultural conditioning, beliefs, thoughts, etc. etc. This is one very important reason why many people with the same injury can have drastically different functional levels (one person can find a certain level of nociception disabling, while another will remain functional).

This topic is not popular with chronic pain sufferers, for many reasons. Some reasons are valid, such as:
1) Resentment towards any mind/psychological/emotional component to pain as a result of being told by doctors that it is 'in the head' (most often because the doctor is unable to identify the cause due to a lack of understanding).
2) The nature of pain, and it's subconscious ability to create a defensive fear-based entrenchment into the very identity of a patient.
3) Addiction to pain, which is both psychological and chemical. Chemical addiction to pain occurs through up regulation of receptor sites and nerve-growth factors being produced as a result of a nociceptor receiving constant pain signals (much the same way a cigarette smoker has an up regulation of nicotinic acetylcholine receptors (nAChR), which causes a 'demand' for this the molecules that bind to the receptor sites). Pyschological addition to pain is a more difficult and taboo subject, and there are many various routes to address this, from spiritual to psychological to psychiatric (pharmaceutical).

Understanding the psychological and neurological and spiritual aspects of pain and suffering is one of the only ways a person can productively deal with their pain. One such teacher who has helped countless chronic pain patients and sufferers effectively deal with their pain is Eckart Tolle. This may resonate well with some patients, and not at all with others. Often, it is the case that a sufferers 'Pain-Body' and 'Ego' will attack any threats to the continuation of pain, thus we often see people react negatively to any methods such as that provided below.

There are may other more scientific lecturers who teach the mechanics of nociception, pain and the psycho-emotional components (and how to overcome being disabled and miserable as a result of pain). Dr. Joe Dispenza, Dr. Bruce Lipton, Dr. Candice Pert, to name a few, are great resources.

Again, this is not a denial of the existence of pain (nor denial of the insult to tissues responsible for nociception seen with PN/PNE), but rather a discussion of management of an important part of chronic pain (and its relation to quality of life).

It is still the case that the physical insult causing the nociception in PN/PNE cases must be addressed. But as with any condition (for example, with cancer patients, research demonstrates that those with a positive affect have higher survival rates than those who do not), the interpretation and perception of pain impacts the course of the disease.

Good luck everyone. I hope some positive direction, any direction at all, is welcomed (as opposed to the negative self-reinforcing behaviours that are all too common on these boards).

http://www.youtube.com/watch?v=2PCSe2cqY_w

[helenlegs 11]

Thank you for your post Dr Andrew. I am sure that anyone who is able to take advantage of the services you offer will be pleased at any reduction in cost. If only you weren't so far away.
Your well wishes are much appreciated.
Thankfully the HOPE forum is more focused on education and targeted treatments rather than negative behaviours, avoidance strategies or any de-conditioning syndromes, potentially culminating in possible pain entrenchment.
The whole pain issue is extremely interesting tho'. The problem being that so many of us have already been 'branded' with this hot (popular) iron as it is very easy to level in our direction, when what is required is a little more thought by many who are stuck in their own speciality, allowing the pelvic pain conundrum to continue.
Thanks again ,
Helen