Watch Georgie Oldfield, a pain physiotherapist in the UK, interview Lizzie about Lizzie's recovery from chronic pelvic pain using the Curable App and Pain Reprocessing Therapy (PRT). Many of my patients have benefited from using the Curable app, PRT  (a mindfulness technique), and/or clinical hypnosis to feel safe and let go of the various beliefs, anxiety, and fears that underly much chronic pain. Some people feel better quickly; others more gradually. 

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An organization founded by people who have recovered from chronic pain provides resources and recounts many personal stories of recovery from chronic pain using Dr. John Sarno's approach and related techniques such as Pain Reprocessing Therapy. Their YouTube channel is well worth checking out. Ask Dr Bowler how you can explore these concepts. 

Not very many people enjoy injections or procedures involving needles - except when they have found treatments such as trigger point injections, prolotherapy, perineural injections therapy so helpful that they eagerly anticipate their next visit to the clinic. Some, however, who could benefit from dental visits or medical procedures, postpone or avoid them due to a needle phobia. Needle Phobia is much more than a simple dislike of the discomfort associated with needles; a person with a needle phobia feels sudden severe anxiety, panic, perhaps nausea or may even faint at the the mere thought of a needle, or hearing someone describe an injection, or sees a picture or movie about medical procedures. Clinical hypnosis addressing the root cause of such fears can eliminate the phobia, usually in one or two sessions. You don't have to actually like having injections to be free of an unnecessary phobia. 

A medical student tells her story about The Connection between Pelvic Pain & Childhood Trauma in this fascinating article. Pain Reprocessing Therapy (PRT) and clinical hypnosis are among the most successful approaches to reducing or eliminating such pain once serious conditions have ben excluded and one understands the links between the brain and the gut and other pelvic organs such as the bladder. Even when structural conditions such as endometriosis or polycystic ovarian syndrome are diagnosed understanding the connections between past experiences, stress, and how the nervous system processes sensations can significantly change one's perception of pain. Humans are not alone in this! Similar links between fear/stress and pelvic or bladder symptoms have been found in cats. 

Pain Reprocessing Therapy (PRT) and clinical hypnosis are among the most successful approaches to reducing or eliminating such pain once serious conditions have been excluded and one understands the links between the brain and the gut and other pelvic organs such as the bladder and reproductive organs.​ Both are offered at this office. 
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An excellent article about persistent pain in the abdomen and pelvis and its links to other conditions was published in in June 2022. 
 Obstet Gynecol Clin North Am. 2022 June ; 49(2): 219–239. doi:10.1016/j.ogc.2022.02.006.

"At least 15–20% of women suffer from chronic pelvic pain, which is defined as pain occurring in the abdomen or pelvis for at least 14 days per month and is severe enough to cause functional limitations or prompt medical care.1 This condition has a profound impact on physical health, emotional well-being, and ability to function across family, social, and professional roles. Chronic pelvic pain is notoriously challenging to manage, frustrating patients and clinicians alike.......

"......Patients with chronic pelvic pain very frequently suffer from other non-pelvic pain conditions, particularly those that comprise the Chronic Overlapping Pain Conditions (COPCs). COPCs are a set of chronic pain conditions that have a highly probability of co-occurrence and appear to share common underlying mechanisms and risk factors. Two gynecologic pain conditions are included in the National Institutes of Health Pain Consortium list of COPCs: endometriosis and vulvodynia. But COPCs also include both pelvic (interstitial cystitis/bladder pain syndrome and irritable bowel syndrome) and non-pelvic conditions (fibromyalgia, temporomandibular disorders, migraine headache, chronic tension-type headache, chronic low back pain, and myalgic encephalomyelitis/ chronic fatigue syndrome). The conditions that contribute to chronic pelvic pain symptoms in one person often differ greatly from those that contribute in another and can change in any given patient over their life course.
"Presence of persistent pain, regardless of specific etiology or location, can lead to increased sensitization of the central nervous system – in other words, predisposing patients to development of additional chronic pain conditions.3,4 Notably, patients with multiple chronic pain conditions often respond less robustly to treatments focused on individual conditions.5–7 Therefore, it is essential to approach management of chronic pelvic pain in a comprehensive manner, which includes identification of all conditions that contribute to pain symptoms and optimal management of each contributing condition." 

You may have heard of someone with "phantom limb pain" in a person who has had a limb amputated - often they can still feel the toes in a missing leg. This is because each part of our body is represented on the surface (cortex) of the brain and the brain can produce, reproduce, or perpetuate any sensation, even when a part of the body is no longer present or has healed. Chronic pelvic pain is similar - it may occur in someone who has had previous illness, injury, or assault, or who has had an unhappy relationship leading to fear of intimacy. The pain may persist long after any injury or illness has healed and there is no longer any structural reason for it - the neural circuits continue to fire, giving the sensation of persistent pain. In some cases vulvodynia - persistent pain in the vulva - can behave in a similar way. 

Once serious structural conditions have been excluded by appropriate medical examination, laboratory tests, and imaging, it is appropriate to consider safe and effective ways of managing it without invasive surgery or potentially hazardous drugs. Pain Reprocessing Therapy and clinical hypnosis are two such safe, respectful, and effective therapies offered at our office. 

The following abstracts represent just a few of the many peer-reviewed scientific journal articles on clinical hypnotherapy for IBS. Our program is based largely the research of Palsson and Whorwell, mentioned below. 

Tan, G., Hammond, D. C., & Gurrala, J. (2005). Hypnosis and Irritable Bowel Syndrome: A Review of Efficacy and Mechanism of Action. American Journal of Clinical Hypnosis, 47(3), 161–178. doi:10.1080/00029157.2005.1040 Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by abdominal pain, distension, and an altered bowel habit for which no cause can be found. Despite its prevalence, there remains a significant lack of efficacious medical treatments for IBS to date. In this paper we reviewed a total of 14 published studies (N = 644) on the efficacy of hypnosis in treating IBS (8 with no control group and 6 with a control group). We concluded that hypnosis consistently produces significant results and improves the cardinal symptoms of IBS in the majority of patients, as well as positively affecting non-colonic symptoms. When evaluated according to the efficacy guidelines of the Clinical Psychology Division of American Psychological Association, the use of hypnosis with IBS qualifies for the highest level of acceptance as being both efficacious and specific. In reviewing the research on the mechanism of action as to how hypnosis works to reduce symptoms of IBS, some evidence was found to support both physiological and psychological mechanisms of action.

Palsson, O. S., Turner, M. J., Johnson, D. A., Burnett, C. K., & Whitehead, W. E. (2002). Hypnosis Treatment for Severe Irritable Bowel Syndrome Investigation of Mechanism and Effects on Symptoms. Digestive Diseases and Sciences, 47(11), 2605–2614. doi:10.1023/a:1020545017390 Hypnosis improves irritable bowel syndrome (IBS), but the mechanism is unknown. Possible physiological and psychological mechanisms were investigated in two studies. Patients with severe irritable bowel syndrome received seven biweekly hypnosis sessions and used hypnosis audiotapes at home. Rectal pain thresholds and smooth muscle tone were measured with a barostat before and after treatment in 18 patients (study I), and treatment changes in heart rate, blood pressure, skin conductance, finger temperature, and forehead electromyographic activity were assessed in 24 patients (study II). Somatization, anxiety, and depression were also measured. All central IBS symptoms improved substantially from treatment in both studies. Rectal pain thresholds, rectal smooth muscle tone, and autonomic functioning (except sweat gland reactivity) were unaffected by hypnosis treatment. However, somatization and psychological distress showed large decreases. In conclusion, hypnosis improves IBS symptoms through reductions in psychological distress and somatization. Improvements were unrelated to changes in the physiological parameters measured.

Palsson, O. S., & Whitehead, W. E. (2002). The growing case for hypnosis as adjunctive therapy for functional gastrointestinal disorders. Gastroenterology, 123(6), 2132–2135. doi:10.1053/gast.2002.37286 The availability and affordability of this therapy would be vastly increased if the same kind of face-toface hypnosis treatment found effective for FD and IBS would also help patients when administered exclusively in a home-treatment audio format. No data have been presented to date to make it possible to conclude whether this is feasible. In conclusion, although some of the studies to date on hypnotherapy for functional GI disorders have been small and lacking in methodological rigor, and many research questions remain unanswered, the cumulative and consistent evidence for efficacy of hypnotherapy for these disorders seems to warrant serious consideration of its use as a regular adjunct in primary care and gastroenterology treatment of patients with FD and IBS.

Review of the Empirical Evidence. American Journal of Clinical Hypnosis, 58(2), 134– 158. doi:10.1080/00029157.2015.1039 Hypnotherapy has been investigated for 30 years as a treatment for gastrointestinal (GI) disorders. There are presently 35 studies in the published empirical literature, including 17 randomized controlled trials (RCTs) that have assessed clinical outcomes of such treatment. This body of research is reviewed comprehensively in this article. Twenty-four of the studies have tested hypnotherapy for adult irritable bowel syndrome (IBS) and 5 have focused on IBS or abdominal pain in children. All IBS hypnotherapy studies have reported significant improvement in gastrointestinal symptoms, and 7 out of 10 RCTs in adults and all 3 RCTs in pediatric patient samples found superior outcomes for hypnosis compared to control groups. Collectively this body of research shows unequivocally that for both adults and children with IBS, hypnosis treatment is highly efficacious in reducing bowel symptoms and can offer lasting and substantial symptom relief for a large proportion of patients who do not respond adequately to usual medical treatment approaches. For other GI disorders the evidence is more limited, but preliminary indications of therapeutic potential can be seen in the single randomized controlled trials published to date on hypnotherapy for functional dyspepsia, functional chest pain, and ulcerative colitis. Further controlled hypnotherapy trials in those three disorders should be a high priority. The mechanisms underlying the impact of hypnosis on GI problems are still unclear, but findings from a number of studies suggest that they involve both modulation of gut functioning and changes in the brain’s handling of sensory signals from the GI tract.

Whitehead, W. E. (2006). Hypnosis for Irritable Bowel Syndrome:The Empirical Evidence of Therapeutic Effects. International Journal of Clinical and Experimental Hypnosis, 54(1), 7–20. doi:10.1080/00207140500328708 Abstract: Irritable bowel syndrome (IBS) is a complex and prevalent functional gastrointestinal disorder that is treated with limited effectiveness by standard medical care. Hypnosis treatment is, along with cognitive-behavioral therapy, the psychological therapy best researched as an intervention for IBS. Eleven studies, including 5 controlled studies, have assessed the therapeutic effects of hypnosis for IBS. Although this literature has significant limitations, such as small sample sizes and lack of parallel comparisons with other treatments, this body of research consistently shows hypnosis to have a substantial therapeutic impact on IBS, even for patients unresponsive to standard medical interventions. The median response rate to hypnosis treatment is 87%, bowel symptoms can generally be expected to improve by about half, psychological symptoms and life functioning improve after treatment, and therapeutic gains are well maintained for most patients for years after the end of treatment.

​Whorwell, P. J., Prior, A., & Faragher, E. B. (1984). CONTROLLED TRIAL OF HYPNOTHERAPY IN THE TREATMENT OF SEVERE REFRACTORY IRRITABLE-BOWEL SYNDROME. The Lancet, 324(8414), 1232–1234. doi:10.1016/s0140-6736(84)92793-4 30 patients with severe refractory irritable bowel syndrome were randomly allocated to treatment with either hypnotherapy or psychotherapy and placebo. The psychotherapy patients showed a small but significant improvement in abdominal pain, abdominal distension, and general well-being but not in bowel habit. The hypnotherapy patients showed a dramatic improvement in all features, the difference between the two groups being highly significant. In the hypnotherapy group no relapses were recorded during the 3-month follow-up period, and no substitution symptoms were observed.
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Dr David Bowler is now offering Pain Reprocessing Therapy to patients with chronic neuroplastic or stress-related pain and post-trauma. This is an evidence-based clinical therapy taught by the Pain Reprocessing Therapy Center in LA. PRT is the basis of the processes enjoyed by the many users of the popular Curable App.   

Alan Gordon and Alon Ziv recently published their book on Pain Reprocessing Therapy (PRT), a safe and effective process validated in a clinical study in Boulder Colorado in which the majority of chronic back pain patients who participated in the  PRT counselling process had most or all of their pain resolve. The study is worth reading, as is their book.