Vulvodynia: Pain Management Strategies

Merlino, Lucia; Titi, Luca; Pugliese, Francesco; D’Ovidio, Giulia; Senatori, Roberto; Rocca, Carlo Della; Piccioni, Maria Grazia

doi:10.3390/ph15121514

Cited by 5 publications

(2 citation statements)

References 57 publications

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“…Regarding the therapeutic approach of vulvodynia, a stepwise method of pelvic floor dysfunction treatment, adequate psychological support, and sexual healthcare is recommended along with medical therapies [35]. Intermittent use of topical lidocaine cream may be useful for women with intense vestibular touch pain, prior to sexual intercourse [36].…”

Section: Vulvodyniamentioning

confidence: 99%

Nociplastic Pain in Gynecology: Understanding This Painful Experience in Women

Merlino,

Crognale,

Grazia Piccioni

et al. 2024

Pain Management - From Acute to Chronic and Beyond

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The term “nociplastic pain” was introduced in 2017 by the International Association for the Study of Pain (IASP) to describe pain that results from impaired nociception despite no clear evidence of actual or potential tissue damage causing activation of peripheral nociceptors or evidence of disease or lesion of the somatosensory system causing the pain. It is a definition born from the need to recognize early the presence of central sensitization of the nervous system in patients with chronic pain; we can find ourselves in the co-presence of nociceptive or neuropathic pain and nociplastic pain. In gynecological pathology, nociplastic pain plays an important role characterizing some important pathologies that can be associated with chronic pelvic pain in women. It is essential to understand the mechanisms of pathogenesis and maintenance of nociplastic pain in order to undertake a multidisciplinary path for the treatment of these patients.

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Section: Vulvodyniamentioning

confidence: 99%

Nociplastic Pain in Gynecology: Understanding This Painful Experience in Women

Merlino,

Crognale,

Grazia Piccioni

et al. 2024

Pain Management - From Acute to Chronic and Beyond

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“…The International Society for the Study of Vulvovaginal Diseases defines localized provoked vulvodynia (LPV) as vulvar pain lasting at least 3 months without readily detectable accompanying inflammation or infection ( Bornstein et al., 2016 ). While LPV affects 8-28% of cis-gender, female-identifying individuals during their lifetime ( Reed et al., 2004 ; Reed et al., 2012 ; Harlow et al., 2014 ), it is frequently misdiagnosed and lacks effective therapeutic approaches ( Merlino et al., 2022 ). However, self-reported history of allergies to pollen and insect venom, and recurrent vulvovaginal yeast infections are both associated with an increased incidence of vulvodynia ( Sarma et al., 1999 ; Witkin et al., 2002 ; Harlow et al., 2009 ; Marfatia et al., 2016 ; Harlow et al., 2023 ) suggesting that immune mechanisms may be involved in its underlying pathophysiology.…”

Section: Introductionmentioning

confidence: 99%

Immune mechanisms in vulvodynia: key roles for mast cells and fibroblasts

Tonc,

Omwanda,

Tovar

et al. 2023

Front. Cell. Infect. Microbiol.

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Vulvodynia is a debilitating condition characterized by painful sensitivity to touch and pressure in the vestibular tissue surrounding the vaginal opening. It is often a “diagnosis of exclusion” of idiopathic pain made in the absence of visible inflammation or injury. However, the association between increased vulvodynia risk and a history of yeast infections and skin allergies has led researchers to explore whether immune mechanisms of dysregulated inflammation might underlie the pathophysiology of this chronic pain condition. Here we synthesize epidemiological investigations, clinical biopsies and primary cell culture studies, and mechanistic insights from several pre-clinical models of vulvar pain. Taken together, these findings suggest that altered inflammatory responses of tissue fibroblasts, and other immune changes in the genital tissues, potentially driven by the accumulation of mast cells may be key to the development of chronic vulvar pain. The association of increased numbers and function of mast cells with a wide variety of chronic pain conditions lends credence to their involvement in vulvodynia pathology and underscores their potential as an immune biomarker for chronic pain. Alongside mast cells, neutrophils, macrophages, and numerous inflammatory cytokines and mediators are associated with chronic pain suggesting immune-targeted approaches including the therapeutic administration of endogenous anti-inflammatory compounds could provide much needed new ways to treat, manage, and control the growing global pandemic of chronic pain.

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Efficacy of Rehabilitative Techniques on Pain Relief in Patients With Vulvodynia: A Systematic Review and Meta-Analysis

Calafiore,

Marotta,

Curci

et al. 2024

Physical Therapy

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Objective Vulvodynia is a chronic clinical condition characterized by provoked or non-provoked vulvar pain for at least 3 months of unknown etiology. The onset of vulvodynia involves a complex interplay of peripheral and central pain mechanisms, such as pelvic floor muscle and autonomic dysfunction, and interpersonal factors. A stepwise approach of pelvic floor physical therapy as medical management is suggested. In this scenario, by this meta-analysis of randomized controlled trials, we aimed to evaluate the efficacy of rehabilitation interventions in patients with vulvodynia. Methods On 13th October 2022, PubMed, Scopus, and Web of Science were systematically searched for randomized controlled trials that assessed the efficacy of the rehabilitative approach to pain during intercourse in patients with vulvodynia. The quality assessment was performed with the Cochrane risk-of-bias tool for randomized trials. The trial registration number is CRD42021257449. At the end of the search, 9 studies were included for a total of 332 patients. A pairwise meta-analysis was performed to highlight the efficacy of rehabilitative approaches for reducing pain during intercourse, as measured with a visual analog scale or a numerical rating scale. Results Meta-analysis showed that all these rehabilitative approaches had an overall effect size of −1.43 (95% CI = −2.69 to −0.17) in decreasing vulvodynia pain in terms of the visual analog scale. In the subgroup analysis, a significant effect size in acupuncture (effect size = −2.36; 95% CI = −3.83 to −0.89) and extracorporeal shockwave therapy (effect size = −2.94; 95% CI = −4.31 to −1.57; I2 = 58%) was observed. According to the Cochrane risk-of-bias tool, a low risk of bias for outcome selection in 89% of studies. Conclusions Findings from this meta-analysis suggested that the physical agent modalities and complementary medicine techniques in people with vulvodynia appear to be more effective than placebo, sham, or waiting list. Further evidence on physical agent modalities and complementary therapies are warranted in the future. Impact This was the first systematic review and meta-analysis of randomized controlled trials to provide evidence on the efficacy of rehabilitation interventions in patients with vulvodynia.

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Vulvodynia: Pain Management Strategies

Cited by 5 publications

References 57 publications

Nociplastic Pain in Gynecology: Understanding This Painful Experience in Women

Nociplastic Pain in Gynecology: Understanding This Painful Experience in Women

Immune mechanisms in vulvodynia: key roles for mast cells and fibroblasts

Efficacy of Rehabilitative Techniques on Pain Relief in Patients With Vulvodynia: A Systematic Review and Meta-Analysis

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