Significant Improvement Noted in Vulvodynia when Pelvic Neurogenic Inflammation is Addressed

Synopsis/Brief Summary Vulvodynia is effectively treated by the PRM Protocol™, which improves pain, function, and quality of life in patients with chronic pelvic pain. Objective: Vulvodynia, characterized by chronic pain and/or discomfort around the opening of the vulva, is known to affect up to 16% of adult women and may present as constant or intermittent pain that negatively impacts patients’ personal and working lives, as well as mental health and relationships. This study aimed to test the effectiveness of a multimodal neuromuscular treatment protocol in treating chronic pelvic pain and vulvodynia symptoms and improving pain and function. Methods: 59 patients ages 20-79 presented to an outpatient clinic with pelvic pain and Vulvodynia symptoms. These symptoms had, on average, persisted for 6 years. All patients underwent a once-weekly, six-week treatment (the PRM Protocol) consisting of ultrasound-guided pelvic floor musculature trigger-point injections and peripheral nerve blocks. To measure the effects of this treatment, a 0-10 Visual Analogue Scale (VAS) was used to measure pelvic pain intensity, and the Functional Pelvic Pain Scale (FPPS) was used to measure function across multiple areas. These measures were taken on patients’ first visit to a clinic and three months after treatment began. Results: VAS scores improved by an average of 51%. Before treatment, the mean VAS score was 7.93 (SD=1.61) (a=0.05; CI 7.52-8.34), and the posttreatment mean VAS score was 3.9 (SD=2.19) (a=0.05; CI 3.34-4.46) (P<0.0001). Pelvic pain functionality improved by 23% after three months. Pretreatment FPPS scores averaged at 12.34 (SD=5.8) (a=0.05; CI 10.86-13.82), decreasing to 9.53 (SD=5.43) (a=0.05; CI 8.14-10.91) after treatment (P<0.0001). FPPS functions that showed the most significant improvement were Sleep, which improved by 39%; Intercourse, which improved by 28%; and Walking, which improved by 28%. Conclusions: These results indicate that a six-week treatment consisting of once-weekly ultrasound-guided pelvic floor musculature trigger-point injections and peripheral nerve blocks combined with once-weekly pelvic floor physical therapy was very effective at relieving pain and improving function for patients with Vulvodynia. Significant reductions in opiate use, ER visits, and pain interference at work were observed following treatment.