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Pelvic pain, pudendal neuralgia, rectal pain, levator ani, pelvic floor dysnfunction SYMPATHETIC RESET Using Amniotic Growth Factors to Reboot the Sympathetic Nervous System Learn More

What is a "Sympathetic Reset?"

The longer the human body experiences pain, the more it changes the wiring of the peripheral nervous system and how it communicates pain signals into the central nervous system… these changes are what makes chronic pain so challenging to treat. With each passing day, pain discovers new shortcuts to get around and find its way into the brain to tell it that you should be suffering from an injury that happened months ago, or maybe never at all, nonetheless your brain can’t tell the difference – the prime culprit for these shortcuts is the sympathetic nervous system. So, what’s the answer when this happens?

How do you stop pain signals from taking short cuts and moving around the peripheral nervous system unchecked?

The answer: Reset the sympathetic nervous system.

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What’s the SNS?

The sympathetic nervous system (SNS) is a complex web of nerve fibers and cell bodies located throughout the body that controls vital bodily functions.

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Whose it For?

A Sympathetic Reset is a valuable therapeutic option for complex pelvic pain conditions that don’t respond with conventional treatment methods

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How Does it Work?

The SNS can be “blocked” like any nerve in the body – the difference is that when the SNS is blocked, it forces its sensors to recalibrate themselves.

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How Does a “Reset” Work?

The human body uses electricity to communicate orders from the brain to other organs – the most well-known example of this is the EKG signals we see when we monitor the heart.  But this is just one example of the body’s extensive circuitry that is uses to send signals throughout the body on a never-ending basis, most of which happen without us even knowing.  Think of a computer or a smart phone: there are things that we control like opening a program or typing letters that we see show up on a screen, but we forget about all of the other functions that these devices do automatically without us telling it to do like turning on the cooling fan when the CPU gets too hot or knowing where to send electricity/power at different moments.  Sometimes these computers get overwhelmed with all of the tasks they are supposed to responsible for and then they slow down or freeze up.  Well, what do we do when that happens?  We restart it.

This scenario actually happens in the human body more often than we realize.  We have all seen a movie or TV show where one of the characters flat lines and momentarily “dies” on screen, only to be brought back from the dead a few moments later when the hero places electrical paddles on the person’s chest yelling “CLEAR!” as they send a jolt of electricity through the person’s chest, restarting the heart and saving the person’s life.  While it doesn’t work quite like that in real life, the concept of “restarting” or “resetting” an organ system is real. In the real world, we use those paddles to reset the heart during ventricular fibrillation.  Similarly, we also use jolts of electricity to perform something called a cardioversion to again reset the heart during certain arrhythmias.  Another example would be a carotid massage where a doctor applies pressure to the part of the neck to reset the pressure barometers in the carotid arteries to trick the heart into changing its rhythm. 

The sympathetic nervous system (SNS) can be manipulated in a similar way by using sodium channel blockers to temporarily shut down certain hubs (i.e. ganglia or plexus) within the network for a short period of time.  Like the heart, the SNS has sensors that allow the system to take measurements and respond automatically to various situations (i.e. empty a full bladder, close a sphincter during ejaculation, move blood to different parts of the body at different times, etc).  When the SNS goes into overdrive during certain chronic pain conditions, it either chooses to ignore these sensors or recalibrates them to an unsustainable level.  But when it gets turned off, it has to reset these sensors – the key is creating the right environment during that crucial moment to get those sensors to reset to a normal level.  When it resets, the SNS goes back to normal which means autonomic activity returns to normal and, most importantly, the fibers can’t be used as a short cut for pain signals.

SYMPATHETIC NERVOUS SYSTEM The Body's Autopilot Learn More

What is the Sympathetic Nervous System?

autonomic nervous sympatheticThe Sympathetic Nervous System (SNS) is a network of circuits inside the body but outside the central nervous system that allows us to subconsciously control essential functions like digestion, reproduction, blood flow, urinary system, etc.  Along with its counterpart, the Parasympathetic Nervous System (PNS), the SNS is aids in control of the most of the body’s internal organs. The SNS and PNS could be compared to two sides of a coin, as each tends to counteract the other and provide balance to the body. The SNS is known for allowing the body to function under stress in what is known as the fight or flight response, whereas the PNS seems to prefer a calmer state for the body. Research has shown that the SNS plays a major role in chronic pain, particularly neuropathic pain.[1] 

The SNS can either play a role in making chronic pain worse but increasing blood flow to painful and inflammed areas, or it can function as an escape route for pain signals to find their way around the normal set of checks and balances.  In either event, once the SNS becomes in involved in the picture, the pain becomes unresponsive to typical nerve blocks and seems to spread to involve other areas (i.e. left sided pain spreads to involve the right side as well, pain that started in the rectum or genitalia spreads to involve the perineum or the feet, etc).

Some of its functions in the pelvic region include:

  • Filling and emptying the bladder by closing and opening sphincter
  • Ejaculation
  • Regulating blood flow to the pelvic organs and intestines
  • Involuntary contraction of the pelvic floor

Pudendal Neuralgia, Chronic Pelvic Pain, Pudendal neuralgia examination, Pelvic Pain New York CityNeurons in the sympathetic nervous system are located in small structures called “ganglia.”  These ganglia are located in strategic areas throughout the body to regulate specific regions:

As all signals in the SNS travel through these ganglion at some point or other, they provide appropriate targets for pain management to aid in the treatment of “sympathetically-mediated” pain.[2]  Blocking the right ganglion or plexus can effectively block pain signals from an entire at once.  Unfortunately, the block will wear off as the medication is metabolized.  That is where amniotic fluid comes into play.  Read more on this part below…

Pelvic pain, pudendal neuralgia, levator ani syndrome, pelvic floor dysfunction AM I A CANDIDATE??? If your pelvic pain hasn't responded to other treatments, you are not alone...this is where a Sympathetic Reset comes into play Existing Patients Schedule Here

Indications

A Sympathetic Reset is a useful treatment option for a variety of different types of chronic pelvic pain so long as the sympathetic nervous system is involved and playing an active role in the pain.  So how do you know if the sympathetic nervous system is involved?

  Has the pain spread to the opposite side or to another area?
  Has the area of pain become bigger than what it first started out as?
  Are you experiencing burning?
  Is the skin hypersensitive to the point that clothing hurts, or light touch hurts, or even the feeling of water from a bath causes pain?
  Are you experiencing pain with intercourse (i.e. men will feel pain with ejaculation, women feel pain during climax)?
  Are you feeling deep visceral pain (aka pain inside the area where your organs are)?
  Are you experiencing changes in the frequency of your urination and bowel movements?
  Are you feeling pain with bowel movements and/or urination? Have you been told you have IBS (Irritable Bowel Syndrome) or IC (Interstitial Cystitis)?

If you answered yes to any one of these questions, then chances are your SNS is involved and now playing an active role in your pelvic pain.  Unfortunately, standard nerve blocks and physical therapy will not be effective anymore.

Certain pelvic pain conditions have more of a tendency to trigger the SNS than others and move into the SNS at a much faster rate:

  Pudendal Neuralgia
  Levator Ani Syndrome
  Endometriosis
  Post surgical pain
  Vestibulitis
  Vulvdynia
  Prostatitis/Prostadynia

Like any treatment, do your research and ask lots of questions.  Do not rush into any treatment because it “sounds right” for you.  While there is no way to truly and consistently diagnose what is causing your pelvic pain, the most reliable means has always been a diagnostic block – as it pertains to a Sympathetic Reset, a diagnostic block of the Ganglion of Impar, Superior Hypogastric Plexus or both is the first step in seeing if you are a candidate for this therapy.

Why Won’t “Normal” Treatments Work For Me?

Pelvic pain is one of THE most difficult to treat conditions in modern medicine.  The difficulty for finding the right treatment is due in large part to the extreme complexity of the nervous system in the area and the overwhelming number different of nerves and organs in the area – this makes it virtually impossible to pinpoint the exact source of the pain.

  • No matter what treatment you try, you just can’t seem to get lasting relief…
  • You have found treatments that seem to work, but only for a few days or weeks at best, and then the pain just comes right back…
  • You doctors just kept testing you for a UTI and put you on one antibiotic after another…
  • Every test you get seems to come back normal and no one seems to be able to tell you what the problem is…
  • Your pain just seems to be getting worse and worse, and now it’s got to the point that you can’t even sit down…

If any one of these seem to describe you and your pain, you are not alone.  It can take years before patients with pelvic pain find their way to a pain doctor, much less one that specializes in their condition.  By that time, the pain will have spread to a different location because the pain signals are now being generated from a different part of the nervous system, closer to the spinal cord, making it much harder to treat.  Trigger point injections and blind nerve blocks (aka “hydrodissection”) will sometimes offer slight relief, but only for a few days or a few weeks at best.  These injections aren’t really doing anything except flooding the area with local anesthetic which occasionally runs over onto part of the SNS to temporarily block the pain.

HOW DO WE "RESET" THE SNS? Surrounding key elements of the SNS with amniotic growth factors to create the "ideal" micro-environment for it to recalibrate & return to a normal state Existing Patients Schedule Here

Nerve blocks are great treatments for pain…the only problem is they are temporary.  The medication (i.e. bupivavaine or ropivacaine) wears off after a few hours (sometimes a few days if a steroid is added), and then the pain comes right back.  Once the medication get metabolized the nerve wakes up, goes right back to the way it was before the injection and nothing is any different. 

Sympathetic nerve blocks, however, work slightly different because it isn’t just the nerves that are going to sleep and waking back up…it’s the sensors that regulate and measure remote parts of the body for the sympathetic nervous system that are getting turned off and awakened as well. On top of that, we are turning off the cell bodies, themselves, and essentially rebooting the entire circuit, all at once.  The combination of turning both the nerve endings, the cell bodies and the sensors at the same time gives the circuit an opportunity to recalibrate to a different level – hopefully, a normal level.

When the medication wears off and the sympathetic system in the area comes back on line, there is a brief window of time that the sensors and the cell bodies evaluate their surroundings to gauge what kind of condition/state the body is in and what it thinks it should be doing to influence that condition/state.  It is during this window that introduce amniotic fluid into the immediate area to create a euphoric environment for the sympathetic nervous system and trick it into calibrating itself for a body that is in a near perfect state, rather than a stressed and inflammed system that it last experience right before being turned off.

Sympathetic Block + Amniotic Fluid = Complete Reset

When the sympathetic nervous system was turned off, it was in overdrive sending more and more blood to areas that were already swollen and inflamed, sending signals into the spinal cord leading it to wind up and cause neurons to spontaneously fire, telling the adrenal glands to make more catecholamines and other part of the endocrine system to secrete cortisol – both of which cause more and more stress on the body.  It is doing all of this because it believes there is something wrong that it can fix if only it can send enough blood to the area and trigger enough of the body’s regenerative systems to start the healing cascade.  The only problem is there is nothing to heal at this point, and even if there was the cascade isn’t actually healing anything….rather it is making things even worse.  The worse things get, the more it rages on – creating a vicious that it cannot stop.  Sometimes, all one needs to do is just turn off the sympathetic nervous system in a certain area long enough for it to just give the body a break long enough so that when it wakes up from the nerve block, it sees a body in a calmer state that doesn’t need “saving.”  Unfortunately, that isn’t always the case, and it may just chose to go right back to where it left off if it doesn’t know any better, or rather it doesn’t find any signals that it should do something different…this is where amniotic fluid comes into play.

Amniotic tissue is rich with concentrated growth factors and elements that naturally induce healing by triggering the body’s natural regenerative pathways.  By itself, amniotic doesn’t actually heal anything, but rather what it can trick the human body into doing is what causes the healing process.  The shear presence of its contents are enough to coax the body into wanting to heal whatever is in the immediate area.  It is this “healing” state that we introduce around a slowly awakening sympathetic nervous system…essentially setting a stage for the circuit to wake back up, surrounded by an abundance of growth factors that make the system think everything is going well, everything is already in a healing state so it can stand down let whatever the body is clearly doing to heal merely finish.

Targets

There are 2 sympathetic targets for pelvic pain:

  1. Ganglion of Impar
  2. Superior Hypogastric Plexus

Depending on where your pain is, where started, how it started, etc will dictate which of the 2 is the proper target for your condition.

Ganglion of Impar

The ganglion of impar receives innervation from:

  • Perineum
  • Distal rectum
  • Anus
  • Distal urethra
  • Distal vagina
  • Vulva
  • Coccyx
  • Scrotum
  • Vestibule

There is some overlap with the Superior Hypogastric Plexus – particularly around the genitalia

Superior Hypogastric Plexus

The superior hypogastric plexus receives innervation from:

  • Bladder
  • Urethra
  • Vagina
  • Vulva
  • Prostate
  • Uterus
  • Ureter
  • Pelvic Floor (Perineum)
  • Ovaries
  • Penis
  • Testicles
  • Descending Colon and Rectum

The first step in deciding if a sympathetic reset is the right therapy for you is to perform a diagnostic block of either the ganglion of impar or the superior hypogastric plexus to see if either one of these, or maybe both, are playing an active role in your pain.  You will undergo a “diagnostic block” of each of these to see if the sympathetic nervous system is involved, and if so, which of these 2 targets is the most actively involved.  You will know very quickly if it was the right target because the pain will get significantly better in a matter of 30-45 minutes.  In addition, you may feel changes in temperature, skin sensitivity, skin redness or irritation will temporarily improve, and bowel/bladder function may also improve for the time being.  Because this is just a diagnostic block, the effects here will all be temporary and will wear off in a few hours when the medication wears off.  The important thing is if you experience these types of changes, we have not only found a target for your pain, but we have confirmed that the sympathetic nervous system was silently playing an active role in your condition behind the scenes, instigating the situation and making it worse.

Now that we have: a) confirmed the presence of the SNS in your condition, and b) located what part of the SNS is causing the trouble, the next step is to perform the Sympathetic Reset by doing the block again in the same spot, except this time we will be following up the block enough amniotic fluid to bath the plexus/ganglion with enough growth factors to induce the circuits into entering a state of relaxation and potentially allowing the parasympathetic nervous system to take over for a little while.

Is a Sympathetic Reset Right for Me?

If you suffer from chronic pelvic pain condition that has failed to resolve with medications, physical therapy conservative therapies, nerve blocks or even the so called “hydrodisscection,” this procedure may be an option for you.  A sympathetic reset should be performed under the strict supervision of a board-certified pain management specialist.

Contact the Ainsworth Institute to set up an initial evaluation to find out if you are a candidate.

References


[1] Lanz S, Maihöfner C: Symptoms and pathophysiological mechanisms of neuropathic pain syndromes. Nervenarzt. 2009; 80:430-444
[2] Roberts WJ: A hypothesis on the physiological basis for causalgia and related pains. Pain. 1986; 24:297-311
[3] Chaturvedi A1, Dash HH., Sympathetic blockade for the relief of chronic pain, J Indian Med Assoc. 2001;99(12):698-703.
[4] Image from Gray’s Anatomy

 

Suggested Reading

[1] Benzon, Honorio. Essentials of Pain Medicine. Philadelphia: Saunders Elsevier, 2011. Print.
[2] Plancarte R, Amescua C, Patt RB, et al.: Superior hypogastric plexus block for pelvic cancer pain. Anesthesiology. 1990; 73:236-239.
[3] Kanazi GE, Perkins FM, Thakur R, Dotson E. New technique for superior hypogastric plexus block. Reg Anesth Pain Med. 1999; 24:473-6.
[4] Gamal G, Helaly M, Labib YM: Superior hypogastric block. transdiscal versus classic posterior approach in pelvic cancer pain Clin J Pain. 2006; 22:544-547.
[5] Cariati M, De Martini G, Pretolesi F, Roy MT. CT-guided superior hypogastric plexus block. J Comput Assist Tomogr. 2002; 26:428-31.
[6] Wechsler RJ, Maurer PM, Halpern EJ, Frank ED. Superior hypogastric plexus block for chronic pelvic pain in the presence of endometriosis: CT techniques and results. Radiology, 1995; 196, 103-106.
[7] Mishra S, Bhatnagar S, Gupta D, Thulkar S. Anterior ultrasound-guided superior hypogastric plexus neurolysis in pelvic cancer pain. Anaesth Intensive Care. 2008; 36:732-5.
[8] Plancarte R, de Leon-Casasola OA, El-Helealy M, et al.: Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Reg Anesth. 1997; 22:562-568.
[9] deLeon-Casasola OA, Kent E, Lema MJ: Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Pain. 1993; 54:145-151.
[10] Plancarte R, de Leon-Casasola OA, El-Helealy M, et al.: Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Reg Anesth. 1997; 22:562-568.
[11] Rosenberg SK, Tewari R, Boswell MV, et al.: Superior hypogastric plexus block successfully treats severe penile pain after transurethral resection of the prostate. Reg Anesth Pain Med. 1998; 23:618-620.