I’d like to talk about the opioid epidemic that has been in the news the past several years in relationship to the inside job of healing pelvic pain that is outside the reach of all drugs. In recent years, there is what is now called an opioid epidemic has been in the news. Opioid addiction has often begun with the legal prescription of opioids, often after surgery or some procedure. Some group of patients using opioids in this context continued to use them and subsequently became addicted. When I discuss opioids here, I am also including the use of benzodiazepines, like Valium, Xanex, Ativan and clonapin that are used for pain and, like opioids, are also addicting with ongoing use.

There are many people with chronic pelvic pain who have become addicted to opioids and benzodiazepines. These pain medications were probably the only way many doctors felt they had to help these patients with their pain. As we have discovered in our clinical practice with patients who have become dependent on opioids and benzodiazepines, these drugs can work well in the beginning and then progressively diminish in their ability to reduce pain. Also, the pain threshold drops so what didn’t hurt before, hurts with continual opioid use.

The benzodiazepines, we have seen, can be used skillfully to periodically help with pelvic pain when not used regularly, which then helps avoid addiction.   When used occasionally in this way, the benzodiazepines can help someone over the hump of certain flare-ups while not causing addiction. With continued and regular use of opioids or benzodiazepines, however, a higher dosage typically has to be used, to achieve the initial levels of pain relief. After continued regular use, the effectiveness of opioids diminishes in helping pain.

 

Opioid were primarily used in the past to treat terminal, end-of-life pain. Then, for reasons that are beyond the scope of this discussion, these drugs more and more were prescribed for patients who had chronic, non-end-of-life pain. Our society has painfully learned, that the benefit of pain reduction with the regular use opioids and benzodiazepines comes with what could be called a back-end price… namely after extended, continual use, patients both suffer from addiction to the drug, and a diminishing ability of the drug to help their pain. And then there is the issue of opioid deaths. In 2017 a staggering 47000 overdose deaths were recorded in the United States. I doubt any of this.

It is certainly possible to withdraw from opioid use but it isn’t easy or pleasant. Withdrawal from opioids is a major challenge if the opioids have been used for a long time to deal with chronic pelvic pain. Even if there were no issues of pain, opioid withdrawal is difficult. Significantly, added to the issues of withdrawal, the patient taking opioids suffering from chronic pelvic pain has to deal with the huge challenge of how to deal with their chronic pelvic pain if the opioid is taken away. It is not a small problem when you finally try to stop taking the opioids and you have nothing to help you with the pain.

The Wise-Anderson Protocol for pelvic pain is a non-drug method to stop the pain. In 2015, we published a medical article in which we showed that after 6 months of consistently practicing the Wise-Anderson Protocol, 1/3 of our patients, who had been using different kinds of medications, including some with a current or prior history of using narcotics, had stopped the use of all medication.

Our protocol can help reduce or stop the chronic pelvic pain without drugs because it is aimed at eliminating the cause of the problem.

To be clear, our protocol is based on the understanding that the cause of chronic pelvic pain is sore pelvic floor tissue which continues to be irritated by protective muscle guarding and the irritation of nervous arousal. This protective guarding is a reflex to tighten inside the pelvic floor, whose purpose is to protect against anxiety, but in fact the protective guarding exacerbates it. The normal stresses and functions of life also add to the tissue irritation of the painful pelvic tightening. Our focus is to provide a method to heal this sore tissue by providing a healing environment through the core methods we train our patients in. These include a physical method as well as a behavioral method to calm down the aroused nervous system that aggravates the painful pelvis and interferes with the healing of the sore tissue of pelvic floor.

When someone is taking narcotics or benzodiazepines or other drugs, we advise them to not consider going off of their medications, which we ask patients to get medical help with, until they begin to reduce their pain with our method. It is not uncommon for patients to regularly practice our method for months before they feel comfortable in reducing their medications.

With or without the opioid epidemic, we have found that there are no effective drugs for resolving pelvic pain. Resolving the symptoms of pelvic pain is an inside job of healing the sore, tightened tissue of the pelvic floor. This is something one must do oneself, for oneself. We know of no drugs that are able to do this. Opioids and benzodiazepines can temporarily reduce the pain but does little to the underlying cause of the pain. The Wise-Anderson Protocol is designed to give patients the tools that can allow the possibility of carrying out the inside job of healing a sore and tightened inner core.