You have been treating a highly motivated 24-year-old woman with a diagnosis of Interstitial Cystitis/Painful Bladder Syndrome (IC/BPS). The plan of care includes all styles of manual therapy, including joint mobilization, soft tissue mobilization, visceral mobilization, and strain counterstrain. You utilize neuromuscular reeducation techniques like postural training, breath work, PNF patterns, and body mechanics. Your therapeutic exercise prescription includes mobilizing what needs to move and strengthening what needs to stabilize. Your patient is feeling somewhat better, but you know she has the ability to feel even more at ease in their day to day. Is there anything else left in the rehab tool box to use?
Kanter et al. set out to discover if mindfulness-based stress reduction (MBSR) was a helpful treatment modality for (IC/BPS). The authors were interested in both the efficacy of a treatment centered on stress reduction and the feasibility of women adopting this holistic option.
The American Urological Association defined first-line treatments for IC/PBS to include relaxation/stress management, pain management and self-care/behavioral modification. Second-line treatment is pelvic health rehab and medications. The recruited patients had to be concurrently receiving first- and second-line treatments, and not further down the treatment cascade like cystoscopies and Botox.
The control group (N=11) received the usual care (as described above in first- and second-line treatments). The intervention group (N=9) received the usual care plus enrollment in an 8-week MBSR course based on the work of Jon Kabat- Zinn. The weekly course was two hours in the classroom supplemented with a 4-CD guide and book for home meditation practice carryover. The course content included meditation, yoga postures, and additional relaxation techniques.
The patients who participated in the MBSR program reported improved symptoms post-treatment, and perhaps more notably, their pain self-efficacy score (PSEQ) significantly improved. All but one of the participants reported feeling “more empowered” to control their bladder symptoms.
As clinicians working so intimately with our patients, we are often given the privilege of bearing witness to the emotional pain of healing chronic, persistent pelvic pain. We understand how terribly frightening it is for our patients to feel like they will never get better and we see this come out sometimes as fear-avoidance, which has the potential to cascade further into other areas of the social sphere.
If we are able to encourage holistic methods of building strategies to handle the challenges of IC/BPS, our patients will be set up for success in ways beyond the treatment room. While we hope for immediate results in the form of pain relief (which five patients in the study did), we also can appreciate the strategy building for resiliency in the face of persistent pain. As a very strong woman said, “hope serves us best when we do not attach specific outcomes to it”.
Dustienne Miller is the author and instructor of Yoga for Pelvic Pain. Join her in Manchester, NH on September 7-8, 2019 or in Buffalo, NY on October 5-6, 2019 to learn about treating interstitial cystitis/painful bladder syndrome, vulvar pain, coccydynia, hip pain, and pudendal neuralgia with a yoga approach.
Kanter G, Kommest YM, Qaeda F, Jeppson PC, Dunivan GC, Cichowski, SB, and Rogers RG. Mindfulness-Based Stress Reduction as a Novel Treatment for Interstitial Cystitis/Bladder Pain Syndrome: A Randomized Controlled Trial. Int Urogynecol J. 2016 Nov; 27(11): 1705–1711.