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What to Look For in Biofeedback Treatment

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futurehealth.org Headlined to H3 1/26/10

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by John D. Perry & Howard I. Glazer

A few persons on the internet had remarked that they have already tried Biofeedback therapy for their vulvodynia, but without much - or at least without enough -success, so they are still seeking other therapies. Often I have asked them, privately, to describe for me the therapy they received. Their answers were very diverse. The problem is that BIOFEEDBACK is relatively new, and the application of it to Vulvodynia is newer still.

The first work was done by Glazer 8 years ago, but it wasn't until April of 1993 that medical professionals heard about it at the ISSVD Convention. That means, however, that since 1993 we started learning how to use biofeedback to treat vulvodynia. Professional service providers have not studied it in college or graduate school. At best they may have attended a weekend seminar sponsored by experts in their professional group or by the manufacturer of their biofeedback treatment system and computer.

The vast majority of currently practicing clinicians probably have less than two years experience treating vulvodynia with EMG biofeedback. It is a primary purpose of Vulvodynia.com to provide on-going continuing education for such therapists. At the same time we are finding that a majority of our WEB visitors are not professionals, but patients seeking better therapy for their vulvodynia. It is to help the latter group ask the right questions that this page has been developed.

With respect to the application of surface electromyography to pelvic floor muscles in the treatment of vulvovaginal pain, confusion reigns supreme amongst professionals as much as amongst patients. I often hear comments from professionals which clearly indicate that they lump all muscle measurement and treatment together.

They confuse manometry (intravaginal pressure readings) and electromyography. They mistake electrical stimulation for biofeedback. They refer to physical therapy and biofeedback as if they are synonymous. They refer to vulvodynia/vestibulitis as if it is vaginismus (a psychological condition leading to circumvaginal muscles closing off the vaginal opening with attempted penetration). They refer to surface electromyography as if it is fine wire electromyography (a very painful measurement of individual muscle fibers by needle insertion of fine wire directly into the muscle). They mistake biofeedback as a psychological rather than a physical intervention (because biofeedback has its historical roots in the field of psychology) reinforcing inappropriate views held by many that all vulvovaginal pain disorders are essentially psychological. They use the term biofeedback and physical therapy as if they are the same interventions (which they emphatically are NOT). Is it any wonder that patients are confused when the professionals making the referrals hold so many misconceptions about this therapeutic intervention!

Surface Electromyographic Assisted pelvic floor muscle rehabilitation (Biofeedback) treatment of vulvovaginal pain is a very specific treatment.

It involves the use of very specific instruments, software, home training devices, daily exercise protocols and muscle monitoring, specified schedules of office electromyographic evaluations as the basis for determining appropriate at home exercise variables (e.g. number of repetitions, contract duration, relax duration, contract onset/offset times, stability training, spectral frequency training, to mention a few) .

You will find many practitioners who do not conduct treatment in line with any of the above parameters but claim to be conducting biofeedback. This may be a valid claim, they may well be conducting biofeedback. What they are NOT conducting is the GLAZER PROTOCOL.

So what is so important about which protocol is used? Well, it is pretty simple actually. With respect to pelvic floor muscle rehabilitation in the tretment of vulvovaginal pain disorders, ONLY the GLAZER PROTOCOL has been shown to be EFFECTIVE by medical research standards (those standards accepted by the medical community and used by insurance companies to determine reimbursement). This standard involves the collection and analysis of data relating to the effectiveness of the treatment and the publication of this data in a "peer reviewed" medical journal.

Other treatments may be effective but they have NOT demonstrated their effectiveness by this standard. BIOFEEDBACK for vulvovaginal pain remains a PATIENT BEWARE market. I urge you to evaluate your practitioners carefully. DO NOT accept verbal claims of treatment outcome. Neither patient nor practitioner beliefs or unsubstantiated claims about effectiveness are an acceptable standard. Ask your practitioner to see their documented sEMG and patient symptom reports and satisfaction data. If they cannot demonstrate that either 1. They are conducting the GLAZER PROTOCOL in which they have been adequately trained or 2. That they are conducting an alternate treatment protocol which has been demonstrated to be effective, then you have no basis to expect a positive treatment outcome.

Listed below are some questions that you can ask a potential therapist to screen for a promising one, or to review your past therapy and find out if you've really been there, done that. You should not hesitate to ask your therapist these questions, and if you are not satisfied, go somewhere else and try again. After each question we've listed some of the factors which should be weighed in evaluating the professional's answer.

* Will you personally be doing the biofeedback training, or do you have a technician, nurse or aide that does the actual work?

Because biofeedback is labor intensive, hardly any physicians actually do the biofeedback training themselves. If you are seeing a surgeon, he/she is probably trying to decide if you are a good candidate for an operation. Most of the other questions should be asked of the person who will actually be training you.

* How many times have you treated patients like me?

It is OK to work with beginners, everyone has to start somewhere --- IF they are properly supervised and trained.

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http://www.vulvodynia.com/
Howard I. Glazer, Ph.D. Clinical Associate Professor of Psychology in Psychiatry. Clinical Associate Professor of Psychology in Ob/Gyn, Cornell University Medical College.

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