What is Chronic Pelvic Pain?
Chronic Pelvic Pain (CPP) is a complex condition affecting about 1 in 4 adults, causing persistent abdominal-pelvic pain that lasts more than six months. It can stem from various sources, including issues with the reproductive, digestive, urinary, muscular, nerve, and psychological systems, making it hard to diagnose and treat. CPP affects physical and mental health, and there is limited research on effective treatments.
Studying the Effectiveness of the PRM Protocol™ on Chronic Pelvic Pain
This study addresses that gap by exploring the effects of nerve blocks and trigger point injections to relieve pain for CPP patients. CPP often involves increased pain sensitivity, where mild pain feels more intense (hyperalgesia) or non-painful touches cause discomfort (allodynia). Treatment options range from medications to physical therapy, acupuncture, lifestyle changes, and more. This research focuses on a new ultrasound-guided procedure, the PRM Protocol™, to target pain and improve outcomes for those suffering from CPP.
Participants included in this study were 128 patients (92 women and 36 men) aged 18-76 years old diagnosed with CPP and presented to an outpatient pelvic rehabilitation practice between June 2022 and September 2023.
Of the 128 patients, 73 participants were in the treatment group. The treatment group refers to those who completed the PRM Protocol™, a proprietary, patented, simple, office-based procedure to treat the symptoms of chronic abdominal pelvic pain by a direct treatment of inflamed pelvic nerves and spastic pelvic muscles which are often the root cause of symptoms.
Additionally, 55 participants were in the control group (those who did not complete the PRM Protocol™l).
What is the PRM Protocol™?
The PRM Protocol™ is a proprietary, patented, simple, office-based procedure to treat the symptoms of chronic abdominal pelvic pain by a direct treatment of inflamed pelvic nerves and spastic pelvic muscles which are often the root cause of symptoms. This treatment consists of a series of pelvic nerve and muscle treatments to target inflammation in the pelvis, nerve pain, and pelvic floor muscle spasms.
Learn more about treatment at PRM
Administering Treatment Through the PRM Protocol™
1 Preparation
Patients were given a pain reliever (Diclofenac 75 mg) and a numbing spray before the procedure.
2 Trigger Point Injections
Once a week, patients received injections of a numbing medication (Lidocaine 1%) directly into specific pelvic muscles.
The injections targeted muscles such as the iliococcygeus, pubococcygeus, and puborectalis, which are part of the pelvic floor muscles. This was done using a flexible needle guided by ultrasound to ensure precise placement in the tight or painful spots (trigger points) identified in the muscles.
3 Nerve Blocks
While lying on their back, patients received an ultrasound-guided nerve block for the pudendal nerve (a key nerve in the pelvic area) through a safe entry point.
Then, they were repositioned to lie face down, and another nerve block was given to the posterior femoral cutaneous nerve (located near the upper thigh).
The initial treatment used a mix of a steroid (Dexamethasone) and Lidocaine to reduce inflammation and pain. In later treatments, only saline was used for the nerve blocks.
4 Post-Procedure
After the procedure, patients sat on ice for 10 minutes to reduce discomfort and were then able to resume their normal daily activities, including work, on the same day.
This treatment approach, the PRM Protocol™, aims to relieve chronic pelvic pain by targeting both the muscles and nerves contributing to the pain, offering a comprehensive and minimally invasive option for patients.
Following Up with Patients
One year after the final treatment, patients’ responses were evaluated through phone calls. The main focus was on changes in pain levels, which were measured on a scale of 1 to 10 based on their average pain over the last 24 hours.
Additionally, the frequency of opioid use and ER visits was tracked to understand overall well-being. Medical records were reviewed to analyze these outcomes, using statistical tests to compare pain scores, opioid use, and ER visits before and after treatment.
Study Results for the PRM Protocol™
The study showed promising results for patients with chronic pelvic pain who underwent a series of peripheral nerve blocks and trigger point injections:
Pain Reduction
Patients who received the treatment reported a 28% decrease in pain levels over a year. Their average pain score dropped from 7.7 to 5.6 on a scale of 1 to 10. In comparison, those who did not receive the treatment saw only a 10% reduction in pain, from 7.2 to 6.5.
Fewer Surgeries
In the treatment group, 16% of patients had fewer abdominal-pelvic hernia surgeries, compared to 11% in the control group. For endometriosis surgeries, 11% of treated patients had fewer surgeries versus 9% in the control group.
Reduced Procedures
There was a 43% decrease in the need for endoscopy procedures (a type of internal examination) in the treatment group, while the control group saw a 28% decrease.
Reduced Opioid Use and ER Visits
In the treatment group, opioid use dropped from 26% at the beginning to 14% one year after treatment, a 12% decrease. Emergency room visits for pain also decreased from 23% to 10%, a 13% reduction. In contrast, the control group saw a 3% increase in opioid use and a smaller 6% decrease in ER visits.
Overall Improvement in Medical Interventions
The treatment group showed significant reductions in surgeries, medical treatments, and diagnostic procedures compared to the control group.
These results suggest that an office-based neuromuscular treatment can significantly improve pain, reduce opioid use, decrease emergency room visits, and lower the need for surgeries and other medical procedures for patients with chronic pelvic pain, ultimately enhancing their quality of life.
Key Treatment Study Takeaways
This research aimed to evaluate how an office-based treatment involving external ultrasound guided nerve blocks and trigger point injections affects various aspects of life for CPP patients, including pain, daily function, work productivity, quality of life, mental health, sexual health, and use of healthcare services.
- The average pain duration for the 128 study participants was about 10.5 years, highlighting the long-term and severe nature of chronic pelvic pain.
- Patients who received the treatment had fewer surgeries, medical treatments, and diagnostic procedures compared to those who didn’t.
- Both men and women in the treatment group reported significant pain reduction, improving from an average pain score of 7.7 to 5.6 out of 10.
The treatment targets pain in muscles and nerves, which often causes issues like bowel, bladder, and sexual dysfunction. It helps by improving blood flow to the pelvic muscles and reducing pain caused by nerve and muscle issues. - Chronic pelvic pain patients often face difficulties getting proper diagnoses and effective treatments. This can lead to frequent ER visits and numerous unnecessary procedures.
- The study’s retrospective nature means it didn’t use randomized control groups, limiting comparisons with other treatments. More research is needed to understand CPP better and find the best treatments.
The study emphasizes that the PRM Protocol™ is an effective treatment for those suffering with pelvic pain, offering a simple and effective way to manage pain and improve patients’ quality of life.
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Study Authors
Allyson Shrikhande
Neha James
Marjorie Mamsaang
Tayyaba Ahmed
Christian Reutter
Kimberlee Leishear
Rucha Kapadia
Janaki Natarajan
Yogita Tailor
Sandra Sandhu-Restaino
Monica Zirolli
Myesha Banks
Jessica Ray
Katherine Wolfrum
Lolarasi Rampally
Jasmine Ross
Laura Brott
Zita Anigbogu
Gautam Shrikhande
