Judging Costs and Value: Direct Comparisons of Treatment Options
In any life-changing or life-giving procedure, it is wise to directly compare treatment options, including the documented risks, side effects and success rates of your choices. To help you compare the value of the Clear Passage Approach (CPA) to your other options, we offer below a side-by-side comparison of CPA with other treatments using data published in independent peer-reviewed medical journals. Please scroll down to your condition of interest to read the comparison data.
Risk and Side Effects, and a Note About Surgery
Because the alternative of CPA is often surgery, the following risks and side effects apply to virtually all conditions comparing CPA to surgery:
Post-surgical adhesions: Overwhelming evidence shows a primary (and nearly inevitable) risk of surgery is the formation of post-surgical internal scarring (adhesions). No matter how skilled the surgeon, the body creates glue-like adhesions after living tissues are cut or burned. Results of a 57-year review of the side effects of surgery (Liakakos et al., 2001) concluded: “Adhesions occur in more than 90% of the patients after major abdominal surgery and in 55-100% of the women undergoing pelvic surgery. Small-bowel obstruction, infertility, chronic abdominal and pelvic pain, and difficult re-operative surgery are the most common consequences of abdominal and pelvic adhesions.”
Internal infection is a major risk, particularly for bowel obstruction patients where the doctor is cutting through the intestines. Any leakage from the intestines into the body cavity where the patient was cut can cause an internal infection that can quickly become life threatening. Per government statistics, 18% of all bowel resection patients are re-admitted to the hospital within 30 days. (HCUP Net, 2012) A related report in Lancet found that 35% of all open abdominal or pelvic surgery patients were readmitted to the hospital more than twice to treat post-surgical adhesions during the 10 years after their original surgery, with 22% of these ‘follow-up’ surgeries in the first year after surgery. The study noted that “readmissions continued steadily throughout the 10-year period” of the study. (Ellis et al., 1999)
Inadvertent incision: Adhesions can make surgery more difficult, obscuring vital structures behind sheets of scarred tissue. Unable to view clearly, a surgeon can inadvertently cut through a nearby organ, nerve or blood vessel. This is more of a concern in patients with extensive scarring (adhesions).
Surgical side effects
Anesthesia: While some from anesthesia are temporal (nausea, dry mouth, sore throat), evidence from several studies is emerging regarding brain damage from anesthesia. In an article from Scientific American (Storrs, 2014), the author notes that “Anesthesia may have lingering side effects on the brain, even years after an operation.”
- Short-term side effects: Side effects from surgery vary widely, but tend to include pain, swelling, soreness, loss of work and leisure time during recovery.
- Long-term and serious side effects: The primary lasting side effect of surgery is the formation of post-surgical adhesions (see graph above). In the case of bowel obstruction, there is significant concern for post-surgical infection, which can be life threatening, and/or require additional surgery.
CPA risks: The primary documented risks with CPA are temporary soreness in the areas where we work. Patients with lymphedema and Crohn’s patients in an active flare have some risk of exacerbation of symptoms. Please consult us if this is your case.
CPA side effects: CPA patients sometimes become tired during their treatment week; some undergo strong emotions as bound tissues are freed. These responses are generally temporary and dissipate within the week following therapy. CPA patients do not tend to lose work or leisure time, though we ask you to avoid heavy lifting and strenuous exercise for 7 to 10 days after therapy. Positive side effects of CPA around the female reproductive organs often include decreased intercourse pain, increased desire (libido), arousal, lubrication and orgasm. (Wurn et al., 2011; Wurn et al., 2004b)
Benefits and Success Rates: A Side-By-Side Comparison for Various Conditions
Benefits and success rates vary greatly per condition and procedure. We will present these by condition treated under each section below.
Success rates treating female infertility using CPA and other procedures are very well documented. Published medical success rates are generally measured via pregnancy rates, so we used the same measure. In a large peer reviewed study of 1392 women housed in the U.S. National Library of Medicine (NLM), scientists compared the results of the CPA to published success rates for standard medical care. (Rice et al., 2015) These are the findings:
Blocked fallopian tubes
In a study of nearly 1400 women, CPA success rates (in blue) compared well to studies of three different surgical techniques (in green) for pregnancies after opening blocked fallopian tubes. (Rice et al., 2015)
Most physicians advise that surgery to open blocked tubes provides a woman with only a very brief window in which to conceive. In the largest study of its kind ever conducted, only 19% of tubes that were surgically opened remained open six months later. This does not appear to occur with CPA patients, many of whom reported second and third children naturally with no further therapy.
It is important to note that the CPA success rate for opening blocked tubes was 69% for women who had never had surgery to their tubes, but only 35% for those who had undergone a prior surgery – the lower number presumably due to post-surgical adhesions.
Polycystic ovarian syndrome (PCOS)
In a study of nearly 1400 women, CPA success rates (in blue) compared well to studies of surgery (middle bar) and medication (right bar) – both in green. (Rice et al., 2015)
Alternative treatment includes medication (22%), and either of two different surgeries:
- ovarian wedging (cutting and removing a wedge out of the ovary), and
- ovarian drilling (drilling holes in the ovary).
We encourage you to ask your physician about side effects of the medication s/he would prescribe. Surgical risks include creating additional adhesions from cutting and burning these delicate structures within the reproductive system. CPA results were much better in women who had not previously undergone surgery to the ovaries – presumably due to post-surgical adhesions that tend to attach like glue to the delicate reproductive structures, decreasing function.
In a study of nearly 1400 women, success rates with CPA (blue bar at left) and endometriosis surgery (green bars center and right) are nearly identical, with a slight edge toward CPA, as shown below. (Rice et al., 2015)
Some studies indicate that post-surgical endometriosis and adhesion reformation is more prevalent at the sites of prior endometriosis surgery. Other studies do not mention this phenomenon.
Women approaching the end of their reproductive years are often diagnosed with high FSH (follicle stimulating hormone) on day 2 – 5 of their cycle, as the ovary calls on the pituitary to create more and more FSH to help eggs mature.
In a study of nearly 1400 women, 39% of women who are diagnosed infertile or subfertile due to high FSH became pregnant after using the CPA. (Rice et al., 2015)
There is no comparable medical technique, as no treatment for high FSH is known in standard medical care.
In a study of nearly 1400 women, overall IVF pregnancy rates without CPA (37%) were compared to IVF pregnancy rates for women who had first undergone CPA therapy (56%). The overall rates are shown by age below, with pregnancy rates without CPA (in green), and with CPA (in blue). (Rice et al., 2015)
Small bowel obstruction
Measuring success treating small bowel obstruction (SBO) involves measuring a variety of concerns and symptoms. The primary concern for most patients is having another obstruction that requires hospitalization and surgery. Before therapy, our SBO patients often report symptoms that include pain, compromised diet, gastrointestinal problems, and daily fear of having another obstruction. Due to this, they have concern about traveling away from their hospital, and concern with normal social activities, such as visiting friends for meals or attending a social event.
Two ways to measure success
To measure our success addressing all of these symptoms and concerns:
- Eliminated Surgeries: We have very good data and excellent results eliminating future surgeries. Call us for more information, or read the section below.
- Improved Quality of Life: Our scientists created and published a validated Quality of Life Questionnaire to measure symptoms and concerns. This document has now become an accepted part of U.S. medical literature for physicians and scientists to measure success with SBO patients. (Rice et al., 2014b)
After tabulating results to date, we are pleased to report that our patients have reported profound decreases in their required surgeries, and significant improvements in quality of life after therapy, in several areas.
Improved quality of life
In a prospective study recently presented to the 15,000 gastrointestinal physicians and staff at their 2015 International Conference in Washington, D.C. (Digestive Disease Week, May 2015), we measured seven areas of quality of life for our SBO patients, before and after therapy. We noted significant improvements in five of the seven measures and suggestive improvements in the remaining measures. We quantify the improvement of symptoms and numbers of patients that return to “normal” post treatment. Most of these are shown in the following chart of post-CPA results, with blue being ‘normal.’
Significant improvements were noted in
- Pain severity
- Quality of life
- Pain frequency
- Gastrointestinal symptoms
- Range of motion (where adhesions often prevent bending back or to the side, shown on a separate chart)
Suggestive improvements in:
- Need for medication to maintain bowel function (10 of 12 patients were able to completely stop taking their medications post treatment)
- Diet (no patients were on a liquid diet post treatment)
Program Information and Costs
Therapy costs vary widely; you must ask, “What level of service am I getting?” Services such as ice, heat, electrical modalities and group sessions where therapists oversee several patients at a time cost less than hands-on services performed one-on-one in a private treatment room.
We provide highly specialized physical therapy (PT) services. Physical therapists are licensed health care professionals with advanced university degrees in their profession. In the U.S., they are licensed by the state to treat pain and dysfunction, non-surgically.
Clear Passage certified therapists average over 26 years of experience in manual physio/physical therapy. They provide a unique treatment (the Wurn Technique®) that has earned the respect of many fine physicians (see Researchers and Advisors). This therapy represents a unique compilation of advanced manual therapy techniques, combined with techniques we have developed and researched since 1989. We began developing our work as a therapy to treat complex chronic pain patients – those who could not find relief elsewhere. When several women became pregnant despite a diagnosis of infertility, we began to develop protocols for infertility patients. Once we started opening blocked fallopian tubes, it was not a far stretch to start treating blocked intestines or small bowel obstruction. Our results have been published in peer-reviewed medical journals. We treat infertile women, as well as male and female chronic pain and bowel obstruction patients from around the world.
Many try to compare us with massage therapy. We do not provide massage therapy, and it is important to recognize that the Wurn Technique is not massage. Our work is a very specialized, site-specific manual therapy designed to address the adhesions that cause pain and dysfunction. Over 20+ years of study, research, and development of manual therapy techniques, we have significant expertise in the anatomy, function and treatment of the entire body, including post-surgical scars, chronic low back pain, severe recurring headaches, and female reproductive and abdominopelvic conditions.
Neither massage nor any other pelvic therapy has published results proving effectiveness treating adhesions and infertility. We are presently developing data for publication of our work with small bowel obstruction. Only the Wurn Technique has been shown in medical studies and citations to:
- decrease adhesions
- improve natural pregnancy rates
- improve IVF success rate
- open blocked fallopian tubes (with live births)
- open hydrosalpinx (with live births)
- decrease endometriosis pain
- significantly decrease intercourse pain, and
- improve sexual function
Fertility Program: Our 20 hour fertility program is our “gold standard”, designed to increase your reproductive function and decrease any chronic or recurring pain in your body. It includes therapy to improve hormonal levels and decrease or eliminate any abdominal, pelvic, bowel, back, hip or tailbone pain you may experience.
Pain Program: Our pain program is designed to address the cause of chronic, unexplained or recurring pain anywhere in the body. Frequent pain complaints we treat include long-standing back, hip, and neck pain; frequent debilitating headaches; pelvic and abdominal pain or cramps; pain from endometriosis, menstruation, or intercourse; full body or unusual pain patterns; and tailbone pain.
Patients coming for pain issues only may attend hourly as needed.
Improved Function Program: Our improved function program is designed to address the causes of decreased function.
Sexual Function – Studies show women who received our therapy experienced significant improvements in all areas of female sexual function (desire, arousal, lubrication, orgasm, and satisfaction).
Bowel Function – We are seeing high success rates increasing intestinal function to improve digestion and decrease constipation, loose bowels, irritable bowel syndrome (IBS), and small bowel obstruction (SBO), breaking the cycle of surgery-adhesions-surgery for our patients. Patients with a history of adhesion-related small bowel obstruction (SBO) generally fall into three categories: mild, moderate and severe adhesions.
Mild adhesions: Patients with histories below generally have mild adhesions. They usually have success after a single 20-hour session of our therapy, with no need for further therapy or SBO surgery.
- a single site-specific abdominal or pelvic surgery, and
- no history of general abdominal or pelvic infection or trauma (such as burst appendix, peritonitis, significant trauma)
Moderate adhesions: Patients with histories below generally have moderate adhesions. They usually require 30 to 40 hours of treatment to achieve success, with no need for further therapy or SBO surgery.
- two or three abdominal or pelvic surgeries without trauma or infection, or
- a mild general infection in the abdomen (e.g., appendicitis, but no burst appendix) or
- zero or one abdominal surgery and moderate trauma in the abdomen (such as moderate to severe endometriosis or a moderate ‘seat belt’ injury) , or
- an abdominal or pelvic infection requiring more than two weeks of antibiotics.
Severe adhesions: Patients with histories below generally have severe adhesions. They usually require 40 hours of treatment, sometimes more, to achieve success, with no need for further therapy or SBO surgery.
- a prior bowel obstruction surgery, or
- severe trauma in the abdomen or pelvis, or
- one or more open adhesion surgeries in the abdomen or pelvis, or
- infection in the abdomen or pelvis (e.g. burst appendix, peritonitis) that required either intravenous antibiotics, or more than two weeks of oral antibiotics.
Any additional history of trauma, infection, inflammation or other surgery could change your suggested number of treatment hours. Your phone consult with one of our therapists will help determine your best protocol for success.
Once you schedule, we provide you with our “Patient Companion” — a location-specific guide designed to assist you to learn what to expect before, during and after therapy including:
- Suggested conversations with your insurance provider
- Area information (maps, hotels, restaurants, etc.)
- Exercises your therapist may prescribe during your visit with us
Most patients find it easiest to schedule the 20-hour program over the course of five days (e.g. Monday-Friday). In this case, you would receive four hours of therapy a day – usually two hours in the morning, then at least an hour break followed by two hours in the afternoon.
Alternately, you may choose to schedule in 10-hour increments or hourly over three months time with a minimum two-hour initial visit. Patients with severe adhesions may benefit from additional hours of therapy.
Costs for your initial 20-hour therapy program are as follows:
|Metro Washington DC||$650||$5,350||$6,000|
|Metro Denver, CO||$650||$5,350||$6,000|
|Metro New York, NY||$750||$6,250||$7,000|
You may call toll free 1 (866) 222-9437 from the U.S. and Canada or 1 (352) 336-1433 from anywhere in the world to reserve your space on our schedule with a deposit. The balance is due at your first visit in Gainesville or five business days prior to your first scheduled appointment at any other location. If you are not satisfied with the care you receive, you may end therapy at any time and receive a full refund of your prepaid unused sessions.
We are pleased to offer a discount to:
• police, firefighters, and military, who put themselves in harm’s way to keep us all safe,
• school teachers, who spend their lives guiding and caring for all of our children, and
• those experiencing financial difficulty (on a case by case basis).
Please call for more details.
Please visit our Insurance and Financing page for more information.
We are committed to finding and treating the cause of your pain or dysfunction. While we have published promising research, scientific evidence of the Wurn Technique® results, the effectiveness of this treatment procedure cannot be guaranteed. If you are not satisfied with the care you receive, you may end therapy at any time and receive a full refund of your prepaid, unused sessions, minus non-refundable deposit.
By Belinda Wurn, PT, National Director of Services, Physical Therapist at Clear Passage Physical Therapy - Gainesville, Florida Area