Presentation from Dr Tayyaba Ahmed, a colleague of Dr Allyson Shrikhande, at Pelvic Rehabilitation Medicine.
https://www.pelvicrehabilitation.com/pelvic-pain-treatment-options-ppt/
This is a medical overview of the unique treatment protocol the physiatrists at Pelvic Rehabilitation Medicine have developed and are helping treat chronic pelvic pain in both men and women.
This provides a brief overview of the nerves, muscles and joints of the pelvic floor and how a whole body approach to pelvic pain can cause lasting improvements to a patient's life.
2. Physiatrists and Pelvic Pain
What role do we play in the pelvis?
- Muscles
- Nerves
- Joints
Using a team approach, we work together with other physicians
(GYN, URO, GI, ORTHO, GEN SURG and others that may be
necessary) to address causes of pelvic pain and then treat it
with pelvic pain specialists (Pelvic Floor PT, Acupuncture, CBT, Movement Specialists,
Nutritionists)
3. CENTRAL NERVOUS SYSTEM PERIPHERAL NERVOUS SYSTEM
- Acupuncture - Pelvic Floor Physical Therapy
- Medications - Hydrodissection Compartment
Blocks
- Mindful Meditation - Movement Specialists
- Craniosacral Therapy
4. “First line” Treatment Options
• Pelvic Floor Physical Therapy- start patient for 6 weeks and re-examine.
• Modalities: TENS UNIT, ultrasound
• Lifestyle Modifications (Diet, Exercise, Sleep, Self-Care, Support)
• Gel Cushion for Pudendal Nerve/Coccyx relief
• SI Joint Belt
• +/- Muscle Relaxant Suppositories for 8-12 weeks
• Oral Nerve Medications and Muscle Relaxants
• Alternative therapies: Acupuncture, Craniosacral, Yoga and Pilates Movement specialists
5. Pelvic Floor Physical Therapy
Improve Pelvic Floor Dysfunction.
Improve Quality of Life by treating symptoms.
Learn Home Exercise Program.
6. Diets
Anti-Inflammatory Diet: Dark Leafy Green vegetables, Celery, Beets, Broccoli, Blueberries, Salmon,
Pineapple, Bone Broth, Walnuts, Coconut Oil, Chia Seeds, Flaxseeds, Turmeric, Ginger, Bok Choy,
Wild Fish
Magnesium Rich Foods: Pumpkin Seeds, Sunflower Seeds, Black Beans, Avocado, Almonds,
Bananas, Chard, Spinach
DIM Diet: Diindolylmethane eliminates estrogen. DIM is found in cruciferous vegetables (Broccoli,
Collard Greens, Bok Choy, Cabbage, Brussel Sprouts) Can also be found in supplement tablets.
Liver Friendly Foods keep the liver doing its job to eliminate excess estrogen. Artichokes, Beets,
Cabbage, Asparagus, Kale, Lemon & Lime, Radicchio, Watercress, Mustard & Dandelion Greens
Interstitial Cystitis Diet: Start by eliminating, citrus, spicy hot foods, MSG, Soy caffeine, sodas,
alcohol, tomatoes, cranberry juice and chocolate.
7. Supplements
Melatonin: The recommended dosage for melatonin is 1 mg to 5 mg. This is
considered to be a safe and effective dosage. It would be a good idea to start first
at the lowest melatonin dosage 1mg and then gradually increase your dosage until
you find the most restful sleep.
Magnesium: The recommended daily dose of elemental magnesium is 400 mg per
day, and a single dose of 800-1600 mg is necessary to produce this laxative effect.
8. Acupuncture
Helps free the flow of energy and blood.
Activates body’s innate healing ability.
Release serotonin, endorphins and
enkephalins which are the body’s natural “painkillers”
Reduces the stress hormone cortisol which causes anxiety and boots energy.
10. Medications
NSAID’s non steroid anti-inflammatory meds
Muscle Spasm Medications oral or suppositories
Nerve Medications
Creams
Try different combinations depending what works for the patient.
Leave steroids up to GYN.
11. Selective HydroDissection
Peripheral Nerve Blocks
Once weekly Injection followed by Pelvic Floor PT within the same week
Series of injections, once weekly for 6 weeks (Or 2x/week for 3 weeks) individually
tailored for patient specific muscles and peripheral nerves to concomitantly
address Myofascial Pain and Neurogenic Inflammation
Ultrasound Guided External Trigger Point Injections to Pelvic Floor Muscles
Ultrasound Guided Peripheral Nerve Hydrodissection Block
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15. What is our Goal?
What does Ultrasound Guided External Trigger Point Injections to Pelvic Floor Muscles do?
Treats the Myofascial Pain with Trigger Point Injection
- Increases Blood Flow
- Decreases Muscle Tension
What does Ultrasound Guided Peripheral Nerve Hydrodissection Block do?
Treats local Neurogenic Inflammation with selective Peripheral Hydrodissection Blocks
- Desensitize peripheral nerves
- Create space for them to flow
16. What is our Goal?
ULTIMATE GOAL: To lengthen, relax and strengthen muscles
Increase blood flow, improve oxygenation
Decrease inflammation and Calm down CNS and PNS
Decrease frequency and intensity of pain levels.
18. Alpha-2 Macroglobulin
1) Largest non-immunoglobulin protein in plasma.
2) Protease Inhibitor- Inactivates a variety of proteinases (The ones that cause
breakdown)
A. Inhibits Fibrinolysis (Plasmin and Kallikrein)
B. Inhibits Coagulation (thrombin)
C. Used for Chronic Pain because it decreases Inflammation
A2M is a “Carrier Protein” that binds to numerous Growth Factors and
Cytokines and carries them away!
19. How is Alpha 2 Macroglobulin different the
Platelet Rich Plasma (PRP)?
With both, blood is withdrawn from a vein in the patient's arm and the blood
is placed in a centrifuge, a machine that spins at a high speed to separate the
different types of blood cells.
PRP contains a high concentration of platelets. PRP causes Inflammation in
hopes to stimulate and optimize your body’s ability to heal the chronic
condition. However, often times will cause a “Flare”
A2M is a protein found in the plasma of blood. It is one component of
platelet-rich plasma that can be isolated from plasma in a centrifuge. A2M
heals by being anti-inflammatory and little chance of causing a “flare”
20. Thank You
18 E 41st St, Suite 2002,
New York, NY 10017
(646) 481-4998
https://www.pelvicrehabilitation.com/
contact@pelvicrehabilitation.com
