From Entropy - Thanks to Jilly for sharing her thoughts on attending the 3rd World Congress on Abdominal and Pelvic Pain in Washington DC this past October. If you're interested in applying for an EPIC scholarship, please stay tuned for more details! We have 2 events coming up in 2018 to support his fund. We will have another EPIC event with Lorimer Moseley in Victoria, BC May 4, 2018. We are also grateful and excited to announce that Paul Hodges has joined the party! We will have an EPIC event with Professor Paul Hodges in Chicago at Entropy on March 2, 2018. We hope to see you there!
Reflecting with distance
When I look back on my career I’m pretty sure that attending the World Conference on Abdominal and Pelvic Pain 2017 in Washington, DC, will have been a turning point for me. An idle conversation with a colleague about the wealth of international knowledge we wished we could access spurred me on to find out if there was funding available. I didn’t really consider that it might happen.
Without Entropy Physiotherapy’s EPIC scholarship in collaboration with Lorimer Moseley, it would have remained a pipe dream. I submitted my entry at the end of a long day in the clinic and crossed everything hoping that I’d get chosen. I was sure that I couldn’t appreciate the value of attending this conference until I was there, and I wasn’t wrong. The sheer volume of knowledge disseminated was vast; from presentations of evidence supporting concepts I was somewhat familiar with but in far greater depth and complexity, to basic brain science that was a real challenge to understand. At one point I asked a physio I was sat next to if this was a “normal” conference for her, or if she was also as blown away by the level of clinically relevant evidence presented and by such a wide array of experts in the field. “Oh yes, this is pretty normal for us. But I’m still amazed, isn’t the body incredible?!”. I’m a regular attendee at our national conferences, but this was truly a world-class event.
It was also an exhausting and exhilarating week – American conferences start early, and events go on late into the night. However, it was at the fundraisers and PT pub nights that I had the most fruitful conversations, where other clinicians and researchers as passionate about pelvic pain as I am shared how they had interpreted the day’s evidence into clinically useful ideas. Names that I have been reading since University were standing around me wanting to talk about what they’d heard, their thoughts, experiences within research and what they thought I needed to be thinking about and reading. These short interactions had a profound impact upon me. I grabbed breakfast with a keynote speaker, unawares, discussing the importance of psychoimmunology over our pastries. I had an amazing conversation whilst walking to the pub with Paul Hodges about how we can personalise treatment, and how we could begin to integrate that into an evidence-based model. At a coffee break, I discussed practical applications of interval training for vagal nerve stimulation with the team who had spent 15 years discovering how and why this could be useful to visceral pain. Over cocktails, I talked about how we could apply graded motor imagery and motor planning to bladder pain, with a researcher currently studying brainy changes who was also interested in the potential of this challenge. And I had a deeply impactful conversation with Shelly Prosko over Dim Sum on the importance of therapist self-care, that has made me take up Yoga. People were enthused, wanting to discuss pelvic pain, and were willing to share their knowledge. I’ve added countless people to my lists of those I follow online, those who I go to for help and solid evidence, and have benefitted from these supportive relationships already through professional mentoring.
A few months on I’m still returning to my notes to process all the concepts I’ve learnt and marveling in the access to experts that the conference provided. Putting together some blog summaries of the week for my colleagues in the UK and worldwide that couldn’t attend has really helped me to reflect and identify my learning points from the conference into the following themes:
- There are complex changes in the motor cortex, sensory cortex, and salience network in those with chronic pelvic pain
- Pelvic pain occurs with multiple and overlapping comorbidities, we have to think about them concurrently in treatment
- The convergence of visceral pain creates a widespread pain state – the “widespreadedness” of pain is important and may denote a phenotype
- Psychoimmunology is important - brainy pro-inflammatory pathways reduce downregulation of the distal inflammatory response in many pelvic pains
- Autonomic changes are important – Bladder Pain Syndrome involves a vagal nerve dysfunction we can affect with interval training and myofascial pain involves a sympathetic vascular dysregulation
The harder part is then how you employ this knowledge. It’s all well and good having an intense learning experience and meeting some incredible members of our research community, but the important bit is how we apply this to clinical practice and help our patients. A few months on from the conference I can reflect now that it’s had a dramatic effect on my clinical work. I’m using tools I did before but with a greater understanding for the mechanisms by which they may work. I’ve started to play with different methods of creating motor and sensory retraining in patients with significant pain. Where I would previously have focussed on building a supportive, therapeutic relationship to allow me to get to the point where it was tolerable to perform manual therapies in order to affect change, I’m now working alongside my patients in the initial phases to build and modulate their motor and sensory awareness in order to produce a more meaningful response to manual treatments. It’s a subtle change but I’m already finding that my manual therapy feels more effective and efficient. All of my pain patients are also now completing interval training, to whatever level is appropriate for them. This has prompted me to engage them in physical exercise much earlier than I usually would in my treatment plans, challenging my previous ideas that it would limit the benefit of manual pelvic floor work by “getting everything tense again” using maladapted strategies – quite the opposite, they’re all improving and they’re enjoying themselves whilst they do! And finally, I’m explaining things more clearly to patients because I understand them more fully.
I’ve also spent some time going through the literature discussed and adding it into the professional development courses I run in the UK for physiotherapists so that the reach of this conference can be maximised. The conference has had a deep impact on my understanding of pelvic pain, the treatments I provide for my patients, and where I look for evidence and learning. I would encourage anyone interested in pelvic pain to attend the world congress, thankfully next time it may be closer to home for me in the UK. Without the EPIC Scholarship from Entropy Physiotherapy and Lorimer Moseley none of this would have happened, I can’t thank them enough for supporting me to attend what was a pivotal moment in my career. See you at the next conference!
