Bert Messelink is a renowned and forward thinking Urologist at the University of Groningen in the Netherlands with a contemporaneous approach to the treatment of pelvic pain and pelvic floor disorders.
With 54 publications to his name Bert is also a highly distinguished researcher in the filed of pelvic pain. Publications include multiple chapters and articles on the European Association of Urology guidelines on chronic pelvic pain over the past decade and his seminal book “Abdominal and Pelvic Pain: From Definition to Best Practice”
In his clinic Bert treats patients with complex pelvic floor problems including chronic abdominal and pelvic pain in men and women. He also organised the very first world congress in the field of abdominal and pelvic pain in Amsterdam back in 2013
Could you provide a brief introduction to who you are and what you do?
I am a urologist and from the start of my working life in urology I was interested in functional problems. I have put my energy in helping to develop a multidisciplinary approach of pelvic floor problems. That started 25 years ago and it is great to see that this approach has become the golden standard. Later on I met people dealing with pelvic pain and joined them in their activities. This has resulted in being the vice chairman of the European Association of Urology guideline on chronic pelvic pain. It also led to the book Abdominal and Pelvic Pain. At the moment I’m still working as a urologist-sexologist and seeing many patients with pelvic pain and sexual problems (often in combination)
Why should Health Care Providers (HCP’s) consider the BioPsychoSocial model when treating male pelvic pain?
The biopsychosocial model helps care providers to take notice of all the different areas of complaints patients are presenting with at their office. In this model we may underline the psychosocial part because this is still the most ignored part of this trias. Surely in pain the role of the brain is of great importance and psychological help will be of great value for men with pelvic pain. And psychological approaches will also address the social effects of pain and how to deal with them.
How do we move away from the culture of lengthy antibiotics to treat pelvic pain especially if all test results are negative?
By sharing the knowledge on pain mechanism. Once we understand that pain is made by the brain to protect us, we can discuss with our patients that antibiotics (like many other drugs) will not work and that they can even worsen the pain. Every course of antibiotics means hope for the patient. The consequent absence of effect is a disappointment, which is without a doubt, registered by the brain and ‘kept in mind’ when another medical treatment is started.
It has been suggested that approximately 20% of all antibiotics prescribed in the UK are ‘inappropriate.’ The UK government has just set out its 5 year plan to ‘tackle antimicrobial resistance’ There is an obligation to look beyond antibiotics as the only treatment for pelvic pain. Current doctrine must change. Here is an article i wrote on the subject of antibiotic stewardship a few years back
What does the future hold for treatment of pelvic pain patients?
We will get more and more insight in the role of the central nervous system, the autonomic nervous system and the immune system. And that will help us in a better understanding of early treatment of pelvic pain by a multidisciplinary team with respect for the BioPsychoSocial aspects.
For more understanding into the BioPsychoSocial applications in pelvic pain you can watch these 2 videos I have pout together
Do you have a take home message for patients and HCP’s? What can they/we do more of/less of?
Read about pain and the role of the brain. Read about the role of pain as part of the complete human being. Realise that everything connects to everything else (Leonardo da Vinci). Take your own role in the process and be aware that self-management is the management that fits you best. Find a care giver to guide you on this way to where you want to go.
I want to thank Bert once again for his time and energy in changing the way we approach, assess and treat pelvic pain. You are a true pioneer in this often overlooked and poorly understood field
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