dc.identifier.citation | Haugstad, G. K., Kirste, U., Leganger, S., Håkonsen, E. & Haugstad, T. S. (2011). Somatocognitive therapy in the management of chronic gynaecological pain : a review of the historical background and results of a current approach. Scandinavian journal of pain, 2 (3), 124-129 | en_US |
dc.description.abstract | Historic background and development of our somatocognitive approach: Mensendieck physiotherapy of
the Oslo School is a tradition of physiotherapy founded by the American physician Bess Mensendieck,
a contemporary and fellow student of Sigmund Freud at the Paris School of Neurology. It builds on the
principles of functional anatomy and the theories of motor learning. We have further developed the theory
and practice from this physiotherapy tradition, challenged by the enormous load of patients with
longstanding, incapacitating pain on western health care systems, by seeking to incorporate inspirational
ideas from body oriented dynamic psychotherapy and cognitive psychotherapy. We developed
somatocognitive therapy as a hybrid of physiotherapy and cognitive psychotherapy by focusing on the
present cognitive content of the mind of the patient, contrary to a focus on analysis of the subconscious
and interpretation of dreams, and acknowledging the important role of the body in pain-eliciting defense
mechanisms against mental stress and negative emotions.
The core of this somatocognitive therapy: (1) To promote awareness of own body, (2) graded task assignment
related to the motor patterns utilized in daily activities, (3) combined with an empathic attitude
built on dialogue and mutual understanding, and emotional containment and support. The goal is for the
patient to develop coping strategies and mastery of own life. In addition, (4) manual release of tensed
muscles and applied relaxation techniques are important.
Methods and results of an illustrative study: One area in particular need of development and research is
sexual pain disorders. We have applied this somatocognitive therapy in a randomized, controlled intervention
study of women with chronic pelvic pain (CPP).Wesummarize methods and results of this study.
Methods: 40 patients with CPP were included in a randomized, controlled intervention study. The patients
were randomized into (1) a control group, receiving treatment as usual (Standard Gynecological Treatment,
STGT) and (2) a group receiving STGT + Mensendieck Somatocognitive Therapy (MSCT). The patients
were assessed by means of Visual Analogue Scale of Pain (VASP), Standardized Mensendieck Test (SMT)
for analysis of motor patterns (posture, movement, gait, sitting posture and respiration), and General
Health Questionnaire (GHQ-30) assessing psychological distress, at baseline (inclusion into study), after
three months of out-patient therapy and at 1 year follow-up. Results: The women averaged 31 years,
pain duration 6.1 years, average number of previous surgical procedures 1.8 per women. In the STGT
group, no significant change was found, neither in pain scores, motor patterns or psychological distress
during the observation period. In the group receiving STGT + MSCT, significant reduction in pain score
and improvement in motor function were found at the end of therapy, and the significant improvement
continued through the follow-up (64% reduction of pain scores, and 80% increase in the average score for
respiration, as an example of motor pattern improvement). GHQ scores were significantly improved for
anxiety and coping (p < 0.01).
Conclusions: Somatocognitive therapy is anewapproach that appears to be very promising in the management
of chronic gynecological pain. Short-term out-patient treatment significantly reduces pain scores
and improves motor function.
Implications: Chronic pelvic pain in women is a major health care problem with no specific therapies and
poor prognosis. A novel, somatocognitive approach has documented positive effects. It is now studied by
other clinical researchers in order to reinforce its evidence base. | en_US |