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Women's Health Channel
Reported September 16, 2009

Ending Pelvic Pain -- In-Depth Doctor's Interview

Michael Hibner, M.D., a gynecologic surgeon at St. Joseph's Hospital and Medical Center in Phoenix, Ariz., talks about various procedures to treat pelvic pain.

What do you hear from the patients who come to you with pelvic pain?

Dr. Michael Hibner: Patients who come here with a diagnosis of chronic pelvic pain often tell me that they were told by their doctors that it’s all in their head and maybe they should just go home and take some Tylenol. They are very desperate because they see many, many specialists – often 15, 20 specialists before they come and see me here.

What do you think about other doctors telling them the pain is all in their head?

Dr. Hibner: I have seen hundreds and hundreds of women with chronic pelvic pain, and I don’t think I have seen a single one in whom I could not find a reason for pain. Of course, chronic pain of any kind will cause symptoms like depression, anxiety ,and sometimes suicidal thoughts, but it’s never, ever in their head. There’s always a reason for pain.

Did you begin developing treatments on your own to address the pain?

Dr. Hibner: When I finished my training in advanced gynecological surgery, I realized that I can’t be just doing surgery.  Surgery is a means to treat the disease and not the goal. My special interest became chronic pelvic pain, mainly because my wife had a lot of back pain issues after her back surgery I decided I want to be treating pelvic pain. I started researching pain and I started researching the causes for pain. I got involved with the International Pelvic Pain Society and met several people who are very knowledgeable of pain and they became my mentors. I have researched the procedures and I have developed some of the procedures on my own that seem to be quite helpful to patients.

Is Botox one of the procedures you use to treat pelvic pain?

Dr. Hibner: Botox is a medication that we all know is used in cosmetology. In treating patients with pelvic pain, it’s very good to relax muscles. A lot of women with chronic pelvic pain develop muscle spasm in their pelvic floor and Botox is very, very good in relaxing those muscles.

Did you develop the nerve decompression procedure from somebody else?

Dr. Hibner: I do several nerve decompression surgeries. The bigg part of my practice right now is the pudendal nerve decompression surgery, which I actually have learned from a surgeon in France who developed this procedure. However, I have modified the procedures so significantly that we believe that our numbers are better than anybody else’s. Therefore, most of the patients right now come here to Phoenix to have this procedure done.

What does the procedure involve and how does it take the pain away?

Dr. Hibner: After I make an incision and I identify the nerve, I make sure that there is no scar tissue around the nerve or there are no ligaments that compress the nerve. I cut all the ligaments surrounding the nerve. After this, I put a protective sheath around the nerve to prevent it from re-scarring.

How well does the procedure work?

Dr. Hibner: Approximately 70 percent of patients do better after surgery. There is probably 30, 35 percent of patients that I cannot help.

How common is this nerve decompression procedure?

Dr. Hibner: It is quite rare, so there are not that many patients. It usually happens after a gynecological procedure or childbirth. There are probably three or four places in the United States where this surgery is done right now, and probably about three places in Europe.

How big a difference does the procedure make for these women?

Dr. Hibner:  100 percent. I mean, it’s a life and death situation. I have seen many patients that were suicidal from their pain. I actually know of several patients that have committed suicide because of a neuropathic type of pain. By neuropathic pain, I mean a pain from the nerve compression,. It’s a different pain than any other pain that we experience.

What can you offer women who’ve gone everywhere and been told it’s all in their heads?

Dr. Hibner: Hope. I first diagnose them with pain and I have to make sure that I know exactly what their reason for pain is. If it is a pudendal nerve compression, then first we try doing injections around the nerve. They are actually not done in the office; they are done by interventional radiologists with the help of a CT scanner. If physical therapy and injections around the nerve fail, then I offer them surgery.

How many women experience pelvic pain of some kind?

Dr. Hibner: Approximately 15 percent of women in the United States have chronic pelvic pain. It is a huge number, yet, about 60, 70 percent of them have no diagnosis. This is by the statistics from the International Pelvic Pain Society.

Do these women need help?

Dr. Hibner: They absolutely need help. To have diagnosis only in 40 percent of them, that’s not right. That means 60 percent of women out of 15 percent of all women in the United States live with chronic pain and they have no diagnosis and no treatment offered to them, and most of them are told that it’s in their head.

For a patient like Shannon, when she came to you, how bad was she?

Dr. Hibner: I think she was in almost suicidal pain because her pain was caused by a nerve injury or nerve compression. She drove here from Yuma, and I told her, ‘I probably can help you.’ We talked about doing a surgical decompression of the nerve, but I offered her injections around the nerve first, and those injections helped. I actually saw her in the office yesterday, and she told me she has had no pain for 28 days straight. No pain for 28 days, and she had 100 percent relief of pain.

How does that make you feel as a doctor?

Dr. Hibner: This is why I do it. I am not here for anything else other than those days when the patients come in and say that they’re a 100 percent better. This is the reason why I’m here. The biggest reward I get is to hear from the patient that they are doing better.

 

END OF INTERVIEW

This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.

 

If you would like more information, please contact:

 

Carmelle Malkovich

Public Relations

St. Joseph's Hospital and Medical Center

Phoenix, AZ

(602) 406-3319

Carmelle.malkovich@chw.edu

 

Sign up for a free weekly e-mail on Medical Breakthroughs called

First to Know by clicking here.

 

Read the full report, Ending Pelvic Pain.

 


 

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