OBJECTIVE To evaluate effectiveness of physical therapy, biofeedback, and/or cognitive behavioral therapy for chronic prostatitis/chronic pelvic pain syndrome (CP and/or CPPS). This symptom complex has resisted resolution from conventional urologic treatment of the prostate, which includes antibiotics, alpha-blockers, and analgesics. Beginning in 1995, a new paradigm was introduced viewing CP and/or CPPS as a psychoneuromuscular disorder driven by protective pelvic floor guarding and psychosocial stress. METHODS A literature search (PubMed, Google Scholar, and the Cochran Library) was conducted from inception through December 2017 using key words related to CP and/or CPPS (eg, prostatitis and pelvic pain) with physical therapy (eg, myofascial trigger point release) and/or biofeedback or cognitive behavioral treatment. Studies were required to include pre- and post-treatment with the National Institutes of Health Chronic Prostatitis Symptom Index (CPSI) scores. RESULTS Eight studies inclusive of 280 patients met primary inclusion criteria. Study sample sizes ranged from 8 to 116 men (mean = 35); treatment duration ranged from 8 to 26 weeks (mean = 14). Pre-treatment mean CPSI scores ranged from 21.7 to 33.5. The nonstandardized weighted mean reduction of CPSI score from baseline was 8.8 points; 95% confidence interval (7.5, 11.1); P <.001. The I-2 statistic = 18.5% indicating little heterogeneity between studies. A sensitivity analysis including an additional multimodal intervention study of with 100 patients produced similar findings. CONCLUSION Conventional medical treatment often fails to resolve CP and/or CPPS. A 6-point reduction in CPSI score is considered a clinically meaningful improvement of symptoms. This meta-analysis shows that treating CP and/or CPPS as a psychoneuromuscular disorder can significantly exceed this clinical threshold. (C) 2018 Elsevier Inc.

OBJECTIVES:Pelvic muscle tenderness occurs often in patients with urologic chronic pelvic pain syndrome; symptoms frequently can be reduced with pelvic myofascial physical therapy. This open-label pilot study evaluated the safety of a personal wand that enables patient's self-treatment of internal myofascial trigger points in the pelvic floor and its effect in reducing pelvic muscle tenderness.METHODS:A specially designed curved wand served as an extended finger to locate and release painful internal myofascial trigger points; an integrated algometer monitors and guides appropriate applied point pressure. Patients used the wand several times weekly after education and careful supervision. Evaluations for adverse events and assessments of pain sensitivity were conducted at 1 and 6 months after commencing use.RESULTS:One hundred and thirteen of the enrolled 157 patients completed 6 months of wand use-106 men and 7 women; 44 patients withdrew before study completion but none for adverse events. Median age was 41 years and 93% were male. Baseline median sensitivity visual analog scale score (1 to 10, 10=most sensitive) was 7.5 and decreased significantly at 6 months to 4 (P<0.001, Wilcoxon matched-pairs signed-rank test). Most patients (95.5%) reported the wand as either very or moderately effective in alleviating pain. No serious adverse events occurred.CONCLUSIONS:A multimodal protocol using an internal pelvic therapeutic wand seems to be a safe, viable treatment option in select refractory patients with pelvic pain.

This study documents the voluntary reduction in medication use in patients with refractory chronic pelvic pain syndrome utilizing a protocol of pelvic floor myofascial trigger point release with an FDA approved internal trigger point wand and paradoxical relaxation therapy. Self-referred patients were enrolled in a 6-day training clinic from October, 2008 to May, 2011 and followed the protocol for 6 months. Medication usage and symptom scores on a 1-10 scale (10 = most severe) were collected at baseline, and 1 and 6 months. All changes in medication use were at the patient's discretion. Changes in medication use were assessed by McNemar's test in both complete case and modified intention to treat (mITT) analyses. 374 out of 396 patients met inclusion criteria; 79.7 % were male, median age of 43 years and median symptom duration of 5 years. In the complete case analysis, the percent of patients using medications at baseline was 63.6 %. After 6 months of treatment the percentage was 40.1 %, a 36.9 % reduction (p < 0.001). In the mITT analysis, there was a 22.7 % overall reduction from baseline (p < 0.001). Medication cessation at 6 months was significantly associated with a reduction in total symptoms (p = 0.03).

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Prostate & Genitalia1 Apr 20111431 SAFETY AND EFFECTIVENESS OF AN INTERNAL PELVIC MYOFASCIALTRIGGER POINT WAND FOR UROLOGICAL CHRONIC PELVIC PAIN SYNDROMES Rodney Anderson, David Wise, Timothy Sawyer, and Brian Nathanson Rodney AndersonRodney Anderson Stanford, CA , David WiseDavid Wise Sebastopol, CA , Timothy SawyerTimothy Sawyer Sebastopol, CA , and Brian NathansonBrian Nathanson Longmeadow, MA View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1343AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urologic chronic pelvic pain syndromes challenge physicians seeking adequate treatment alternatives. Pelvic muscle tenderness phenotypes occur often in these patients and pelvic myofascial physical therapy is helpful. We evaluated safety and tolerability of an internal therapeutic trigger point wand to enable patient self-treatment and determined effectiveness in decreasing pelvic muscle tenderness. METHODS A curved wand served as an extended finger to locate and release painful myofascial trigger points; an integrated algometer sensor monitors point pressure to prevent excessive or dangerous force. Patients used the wand weekly after education and careful supervision by a physical therapist. Assessments of pain sensitivity were conducted at pretreatment, 1 and 6 months; adverse events were documented. There were 169 patients enrolled in the study from October 2008 through mid-December 2009 with intent to obtain a 6-month follow-up. 92% of patients were men and 8% women with a median age of 41 years (25th percentile, 75% percentile; 32.5, 52.5). RESULTS 113 of the enrolled 169 patients completed 6 months of wand use; 56 patients withdrew but none for adverse events. Pelvic muscle sensitivity scores relative to pretreatment were available for 109 patients at 6 months. The median (25thpercentile, 75th percentile) sensitivity before wand use was 7.5 (6, 8.5); it decreased significantly after one month of wand use to a median of 5 (4, 6.5), p<0.001 (paired Wilcoxon matched-pairs signed-ranks test). At 6 months the median sensitivity decreased further to 4 (2.5, 5.5); the median difference in sensitivity was 2.5 (1.5, 4) compared with pretreatment values (p<0.001). Eighty-seven percent (95/109) of patients reported some (>0) reduction in muscle sensitivity and 93% indicated they were very satisfied or moderately satisfied with use of the wand. There were no serious side effects and rare transient episodes of mucosal bleeding. CONCLUSIONS This pilot trial represents an attempt to relieve the painful symptoms of UCPPS in a select population who were seeking treatment beyond the unsuccessful traditional multi-modal therapies they had previously received. Patient self-treatment utilizing a therapeutic wand for myofascial TrP release appears to be a safe, viable and economical chronic pelvic pain management option. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185 Issue 4S April 2011 Page: e573 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.Metrics Author Information Rodney Anderson Stanford, CA More articles by this author David Wise Sebastopol, CA More articles by this author Timothy Sawyer Sebastopol, CA More articles by this author Brian Nathanson Longmeadow, MA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PURPOSE:Chronic prostatitis/chronic pelvic pain syndrome continues to elude conventional therapy. Evidence supports the concept that phenotypes of pelvic muscular tenderness and psychosocial distress respond to myofascial trigger point release and specific relaxation training. This case series reports long-term outcomes of a 6-day intensive combination of such therapies in refractory cases.MATERIALS AND METHODS:A total of 200 men with pain for a median of 4.8 years referred themselves to Stanford University Urology for participation in an established protocol. Daily 3 to 5-hour sessions including intrapelvic/extrapelvic physiotherapy, self-treatment training and paradoxical relaxation training provided a solid introduction to facilitate self-management. Subjects answered baseline and followup questionnaires at variable intervals after initiation of therapy including the National Institutes of Health Chronic Prostatitis Symptom Index, global response assessment and a psychological query.RESULTS:We followed 116 men for a median of 6 months. Baseline total symptom index was 26 out of a maximum 43 points. Scores decreased by 30% (p <0.001) at followup with 60% of subjects demonstrating a 6-point or greater decrease (range 6 to 30). Domains of pain, urinary dysfunction and quality of life showed significant improvement (p <0.001). Global response assessment revealed that 82% of subjects reported improvement (59% marked to moderate, 23% slight).CONCLUSIONS:Men with chronic pelvic pain refractory to traditional treatment benefit from intensive myofascial trigger point therapy and concomitant paradoxical relaxation training. Education in techniques for self-administered trigger point release and continued pelvic muscle relaxation help patients reduce pain and dysfunction. Refinement of clinical phenotyping and selection of patients with pelvic muscle tenderness should enhance the success rate with this treatment modality.

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Prostate & Genitalia1 Apr 2010794 6-DAY INTENSIVE PHYSIOTHERAPY AND COGNITIVE BEHAVIOR CLINIC TREATMENT FOR CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME Rodney Anderson, David Wise, Tim Sawyer, and Patricia Glowe Rodney AndersonRodney Anderson Stanford, CA More articles by this author , David WiseDavid Wise Sebastapol, CA More articles by this author , Tim SawyerTim Sawyer Sebastapol, CA More articles by this author , and Patricia GlowePatricia Glowe Stanford, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1470AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) remains elusive. For patients exhibiting the phenotype of pelvic musculature tenderness, manual physiotherapy and cognitive behavior relaxation training appears to be helpful. The objective of this study was to show outcome benefits of an intensive 6-day immersion clinic in treating severely refractory patients. METHODS Men referred for treatment underwent physical examination, answered pain symptom questionnaires, and then spent several hours per day for 6 consecutive days undergoing myofascial trigger point release and training in paradoxical relaxation. Many patients were taught how to perform their own manipulations. Follow-up symptom scores, psychological status (5-point survey of feelings about disorder and coping with their symptoms) and global response assessments were performed from 3 to 42 months after the training/treatment program. RESULTS We analyzed 125 men who underwent the intensive therapy regimen. Their average age was 49 years (range 20-80); pelvic pain symptom duration average was 7.7±7.8 years with a median of 4.25 years. Follow-up of outcomes occurred after an average 11.8 ± 10.5 month with a median of 7 months. Differences in NIH-Chronic Prostatitis Symptom Index (CPSI) total and domain scores before and after treatment (paired t test) are presented in the Table. Fifty-two percent of the patients self-reported moderate or marked improvements in symptoms on the global response assessment; 14 (11%) indicated no change in their symptoms. Overall psychological benefits averaged 14.2 ± 4.9 (out of maximum score of 21); 25% of patients were exceedingly positive. Sixty-seven percent of patients indicated they continue to utilize cognitive training tapes and 47% continue physical therapy. Of the men completing the therapy, 68% perceived benefit and stated they would participate again or recommend this therapy to a friend. Table 1. Changes in CPSI Symptom Scores Before and After Physiotherapy and Cognitive Behavior Training, Mean ± SD CPSI Scores Pre-treatment Post-treatment p-value Total score 25.3±6.7 18.7±9.1 <0.001 Pain 11.8±3.7 8.8±4.4 <0.001 Urinary 4.4±2.8 3.2±2.8 <0.001 Quality of Life 9.6±2.3 6.9±3.5 <0.001 CONCLUSIONS CP/CPPS patients with long-standing pain, which is refractory to traditional treatment, may benefit from focused myofascial trigger point therapy and cognitive behavior relaxation training. Refinement of phenotyping and selection of patients should enhance the success rate with this treatment modality. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e310-e311 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rodney Anderson Stanford, CA More articles by this author David Wise Sebastapol, CA More articles by this author Tim Sawyer Sebastapol, CA More articles by this author Patricia Glowe Stanford, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PURPOSE:A combination of manual physiotherapy and specific relaxation training effectively treats patients with chronic prostatitis/chronic pelvic pain syndrome. However, little information exists on myofascial trigger points and specific chronic pelvic pain symptoms. We documented relationships between trigger point sites and pain symptoms in men with chronic prostatitis/chronic pelvic pain syndrome.MATERIALS AND METHODS:We randomly selected a cohort of 72 men who underwent treatment with physiotherapy and relaxation training from 2005 to 2008. Patients self-reported up to 7 pelvic pain sites before treatment and whether palpation of internal and external muscle trigger points reproduced the pain. Fisher's exact test was used to compare palpation responses, ie referral pain, stratified by reported pain site.RESULTS:Pain sensation at each anatomical site was reproduced by palpating at least 2 of 10 designated trigger points. Furthermore, 5 of 7 painful sites could be reproduced at least 50% of the time (p <0.05). The most prevalent pain sites were the penis in 90.3% of men, the perineum in 77.8% and the rectum in 70.8%. Puborectalis/pubococcygeus and rectus abdominis trigger points reproduced penile pain more than 75% of the time (p <0.01). External oblique muscle palpation elicited suprapubic, testicular and groin pain in at least 80% of the patients at the respective pain sites (p <0.01).CONCLUSIONS:This report shows relationships between myofascial trigger points and reported painful sites in men with chronic prostatitis/chronic pelvic pain syndrome. Identifying the site of clusters of trigger points inside and outside the pelvic floor may assist in understanding the role of muscles in this disorder and provide focused therapeutic approaches.

PURPOSE:A perspective on the neurobehavioral component of the etiology of chronic prostatitis (CP) and chronic pelvic pain syndrome (CPPS) is emerging. We evaluated a new approach to the treatment of CP/CPPS with the Stanford developed protocol using myofascial trigger point assessment and release therapy (MFRT) in conjunction with paradoxical relaxation therapy (PRT).MATERIALS AND METHODS:A total of 138 men with CP/CPPS refractory to traditional therapy were treated for at least 1 month with the MFRT/PRT protocol by a team comprising a urologist, physiotherapist and psychologist. Symptoms were assessed with a pelvic pain symptom survey (PPSS) and National Institutes of Health-CP Symptom Index. Patient reported perceptions of overall effects of therapy were documented on a global response assessment questionnaire.RESULTS:Global response assessments of moderately improved or markedly improved, considered clinical successes, were reported by 72% of patients. More than half of patients treated with the MFRT/PRT protocol had a 25% or greater decrease in pain and urinary symptom scores, as assessed by the PPSS. In those at the 50% or greater improvement level median scores decreased 69% and 80% for pain and urinary symptoms, respectively. The 2 scores decreased significantly by a median of 8 points when the 25% or greater improvement was first observed, that is after a median of 5 therapy sessions. PPSS and National Institutes of Health-CP Symptom Index showed similar levels of improvement after MFRT/PRT protocol therapy.CONCLUSIONS:This case study analysis indicates that MFRT combined with PRT represents an effective therapeutic approach for the management of CP/CPPS, providing pain and urinary symptom relief superior to that of traditional therapy.

You have accessJournal of UrologyModerated Poster, Saturday, May 21, 2005, 3:30 - 5:30 pm1 Apr 2005112: The Stanford Protocol for Male Pelvic Pain: Integration of Myofascial Trigger Point Release and Paradoxical Relaxation Training Rodney U. Anderson, Christine Chan, Timothy Sawyer, and David Wise Rodney U. AndersonRodney U. Anderson More articles by this author , Christine ChanChristine Chan More articles by this author , Timothy SawyerTimothy Sawyer More articles by this author , and David WiseDavid Wise More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)34377-5AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "112: The Stanford Protocol for Male Pelvic Pain: Integration of Myofascial Trigger Point Release and Paradoxical Relaxation Training." The Journal of Urology, 173(4S), pp. 30–31 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 173Issue 4SApril 2005Page: 30-31 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Rodney U. Anderson More articles by this author Christine Chan More articles by this author Timothy Sawyer More articles by this author David Wise More articles by this author Expand All Advertisement PDF DownloadLoading ...

This paper explores the application of Raman spectroscopy to the examination and analysis of a range media commonly found on works of art on paper. In this case all of the works are from the National Gallery of Australia's collection. Discussion specifically focuses on the practical benefits that a detailed knowledge of inks and pigments can have for both conservators and curators. Through the use of several case studies, different aspects of these benefits are highlighted. Consideration is given to the way in which Raman spectroscopy can supplement the commonly used technique of polarized light microscopy in the identification of inorganic and organic pigments. Comparative results using scanning electron microscopy-energy-dispersive x-ray spectrometry and Fourier transform IR microspectroscopy are also discussed. Works examined include an important but previously undisplayed pastel drawing by the Australian modernist painter Grace Cossington-Smith, a sketchbook by the 19th century Aboriginal artist Tommy McRae and an early 20th century European lithographic poster. Copyright (C) 2004 John Wiley Sons, Ltd.

OBJECTIVE:To determine if emergency personnel, either ambulance or hospital based, can estimate the volume of external blood loss accurately enough to be of potential clinical use in guiding fluid resuscitation.METHODS:A total of 61 ambulance and 35 hospital personnel viewed nine scenarios consisting of volumes of blood (100 mL, 400 mL and 700 mL) spilt onto three surfaces--carpet, vinyl and a clothed manikin. They were asked to estimate the blood loss in each case.RESULTS:Estimates of volumes of blood loss on all surfaces were generally inaccurate. Both ambulance and hospital groups were comparable in this regard. Hospital personnel had higher mean estimates than those of ambulance personnel. Of particular clinical relevance were the findings that blood loss on carpet was underestimated and small volumes on a clothed manikin were overestimated.CONCLUSION:External blood loss estimation by ambulance and hospital personnel is generally too inaccurate to be of clinical use.

This paper considers the academic literature suggesting that the governance and management of charities is far from perfect, a problem that is frequently attributed to the difficulty charities have in recruiting suitable people to act as trustees. The paper raises the question of whether charity governance has a value — and a price worth paying for. The paper describes research carried out to test the attitude of a section of potentially suitable managers to charity trusteeship and to remuneration for such responsibilities. It concludes that there are substantial numbers of able trustees willing to serve on a voluntary basis; the perceived shortage is more likely to arise from charities' own recruitment failings than from a shortage of supply. But it also concludes that the supply of suitable trustees could be doubled if reasonable remuneration were offered, and there is some evidence that existing trustees might give higher priority to their duties if they were paid. Results are based on a sample of just over 100 responses, but a further survey is in progress. Initial results broadly confirm the results reported here. Further research to explore the desirability and practicality of paying charity trustees is indicated. Copyright © 2001 Henry Stewart Publications

The role of voluntary organisations in society and the way such organisations are able to gain finance to support their role, is a continuing source of interest. Charities appear to be becoming more commercial in their selling of goods and services to augment their traditional sources of income. Such trading activity raises sensitive issues of topical interest; notably the way in which charities' income is taxed and the perception of competition between charities and private traders. The research, commissioned by the National Council for Voluntary Organisations (NCVO), throws light on these issues by revealing the nature and extent of trading by charities using authoritative data and a statistically sound sample of charities engaged in trading. Because of legal and taxation constraints on charities, much trading is carried out by subsidiaries rather than by the charities themselves. This study is the first to examine specifically the use of subsidiary companies and to focus on competitive issues. Copyright © 1999 Henry Stewart Publications

The Art BookVolume 1, Issue 4 p. 20b-21 SOUNDINGS The Cross Channel Photographic Mission DAVID WISE, DAVID WISESearch for more papers by this author DAVID WISE, DAVID WISESearch for more papers by this author First published: September 1994 https://doi.org/10.1111/j.1467-8357.1994.tb00195.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume1, Issue4September 1994Pages 20b-21 RelatedInformation

The Art BookVolume 1, Issue 4 p. 22-22 HENRI CARTIER-BRESSON: A PROPOS DE PARIS DAVID WISE, DAVID WISESearch for more papers by this author DAVID WISE, DAVID WISESearch for more papers by this author First published: September 1994 https://doi.org/10.1111/j.1467-8357.1994.tb00199.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume1, Issue4September 1994Pages 22-22 RelatedInformation

Three groups of rats were required to locate a single water bottle from an octagonal array of eight otherwise empty bottles. For one group (place navigation) the goal bottle remained in the same place from trial to trial; for a second group (cue navigation) the position of the goal bottle was cued by a black card over the nozzle; for the third group the goal bottle was uncued and moved randomly from trial to trial. Place and cue groups improved more than controls on all measures of performance. Scopolamine (0.2 mg/kg) substantially impaired performance in the place group, but had no effect on either of the other groups; the peripherally acting anticholinergic drug meth-scopolamine (0.2 mg/kg) had no effect in any group. In a second experiment, using food rewards, scopolamine caused a dose-dependent impairment of place navigation at doses from 0.025 to 0.4 mg/kg; 0.4 mg/kg also impaired cue navigation, but at this dose behaviour was visibly abnormal. In both experiments, scopolamine primarily affected speed of performance rather than accuracy. Olfactory cues were shown not to contribute to performance in either group. The results implicate central cholinergic transmission in the processing of visuo-spatial information.