Multimodal neuromuscular treatment eases pain, improves functionality in vulvodynia

Treatment with once-weekly ultrasound-guided pelvic floor musculature trigger-point injections and peripheral nerve blocks plus once-weekly pelvic floor physical therapy for 6 weeks effectively relieves pain and improves function in patients with vulvodynia, a study has shown.

Fifty-nine patients aged 20 to 79 years who presented to an outpatient clinic for treatment of pelvic pain and vulvodynia, which had persisted for an average of 6 years, were included in this study. All patients went through a once-weekly, 6-week treatment consisting of ultrasound-guided pelvic floor musculature trigger-point injections and peripheral nerve blocks.

The investigators used a visual analogue scale (VAS) to measure pelvic pain intensity and the Functional Pelvic Pain Scale (FPPS) to measure function across multiple areas. They obtained such measurements at the patients’ first visit to a clinic and 3 months after treatment initiation.

VAS scores improved by an average of 51 percent. The mean VAS score was 7.93 (95 percent confidence interval [CI], 7.52‒8.34) prior to treatment and 3.9 (95 percent CI, 3.34‒4.46) post-treatment (p<0.0001).

After 3 months, pelvic pain functionality improved by 23 percent. Pretreatment FPPS scores were around 12.34 (95 percent CI, 10.86‒13.82), which decreased to 9.53 (95 percent CI, 8.14‒10.91) post-treatment (p<0.0001). The most improved FPPS functions were sleep (39 percent), intercourse (28 percent), and walking (28 percent).

“Characterized by chronic pain and/or discomfort around the opening of the vulva, vulvodynia is known to affect up to 16 percent of adult women,” the investigators said.

“Vulvodynia may present as constant or intermittent pain which negatively impacts patients’ personal and working lives, as well as mental health and relationships. The cause of vulvodynia is unknown, and treatment is not widely agreed upon,” they added.