Have you had a cystoscopy, certain that your doctor would find a severe bladder disease (or perhaps even cancer), only to be told that it looked perfectly normal? You then asked, “What’s causing all of my bladder pain?” Your doctor might have shrugged in response, said “We don’t know?” and prescribed yet another bladder treatment for what appeared to be a healthy bladder. Make sense? Of course, it doesn’t.
Dr. Robert Echenberg, one of the pioneering clinicians in pelvic pain, has released a new book that explains this paradox. Chronic bladder, reproductive tract, and bowel pain are often not driven by the organs themselves but by the central nervous system, and the most effective way to ease these patients’ suffering is by implementing strategies that calm nerves and reduce muscle tension. Yet, as he laments, medical schools don’t teach young doctors about pain neuroscience, nor do many professional medical organizations. He is trying to change that.
His book details a groundbreaking pelvic pain treatment program that he has been developing for the past twenty years. The “Echenberg Protocol” is a robust system that can be implemented in clinics around the country that focuses on provider education and skill development, 21st-century neuroscience principles, and, most of all, the implementation of a system that better identifies the underlying cause of pain and the use of more effective treatments. His system is less costly because it results in fewer invasive tests, surgeries, and ER visits and does not force the patient to see multiple specialists, which, for many, is simply too costly.
The challenges for pelvic pain patients are many given the poor understanding of pain processing among organ-specific medical specialties, such as urology, gynecology, urogynecology, or gastroenterology. Dr. Echenberg writes, “Pain management practitioners commonly know little about pain disorders of the pelvis, and pelvic-trained practitioners are not very well-versed in the science of pain processing.” Interestingly, physical therapists have become the new front-line caregivers because their training in neuromuscular aspects of the pelvic region has incorporated some of these neuroscience and trauma-based principles.
His book discusses the challenges of treating sexual pain, genital pain (such as vulvodynia, penile or clitoral pain, and genital hyperarousal disorders – all of which are far more common than we thought in the past. His discussion of interstitial cystitis is insightful, offering ‘IC/BPS as one of the conditions that commonly reveals itself as “the perfect storm” of hypersensitivity in the deep pelvis…’ Of the 2300 complex pelvic pain patients he has seen over the past two decades, 60-75% had bladder pain at least as part of their presenting symptoms.
One key question is how this hypersensitivity starts in the first place. Research suggests that trauma plays a critical role in the development of chronic pelvic pain. The more trauma a patient has experienced, the more the central nervous system amplifies pain throughout the body. He wrote, “A realization of how the body and the brain respond to threats, fear, and other traumatic events is important in understanding the development and evolution of chronic pain in all parts of the body.”
Throughout the book, you’ll find numerous links to research, lectures, videos, and more, highlighting the work of experts in the field, such as Dr. Daniel Clauw at the University of Michigan and Dr Lorimer Moseley at the University of Adelaide in Australia.
Finally, his book discusses the Echenberg Protocol in-depth, including the keys to a successful program, the implementation of the “Explain Pain” educational model, the importance of maintaining safety and compassion for each patient, and the use of minimally invasive treatments that can reduce pain. He said:
“One thing I do know is that if I had known all these principles of how and why chronic pain develops, it would have been so much easier and more effective to treat the many women I met over my previous 35 years of OB/GYN practice. I also now know, after doing 2-to-3-hour initial interviews and detailed physical examinations on over 2200 complex pelvic pain patients over the past several decades, that virtually all the patients I encounter wonder why none of the many specialists they had already seen had ever talked to them about pain itself and how the body normally reacts to trauma.”
His system emphasizes the need for multimodal integrative support to prevent increasing isolation and fear while allowing the body to proceed with the healing it knows how to do. The key to turning down the volume of sensory input is to bring the “dial down” with treatments and therapies that are “low, slow, incremental, and safe.”
As an E-book, this professional memoir contains many “clickable” resources and information about documenting the success of this approach to pelvic and genital pain—both for patients and their healthcare providers. Dr. Echenberg hopes to pass forward a sustainable, teachable model of care and spark further academic study to develop centers of excellence for this underserved population who continue to search for answers, diagnoses, and treatments that make sense to them.
I highly recommend this resource for those of you who are still searching. You will better understand what your body is telling you and how to regain control—and you will want to “pass it forward.”
Learn more and/or buy a copy today at: The Echenberg Institute
