Vulvodynia Topical Treatment – Monotherapy Obsolete


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New topical treatment of vulvodynia based on the pathogenetic role of cross talk between nociceptors, immunocompetent cells, and epithelial cells

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Authors Keppel Hesselink JM, Kopsky DJ, Sajben N
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Journal of Pain Research 2016, 9:757-762

 

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Abstract: Topical treatments of localized neuropathic pain syndromes in general are mostly neglected, mainly due to the fact that most pain physicians expect that a topical formulation needs to result in a transdermal delivery of the active compounds. On the basis of the practical experience, this study brings forth a new, somewhat neglected element of the vulvodynia pathogenesis: the cross talk between the nerve endings of nociceptors, the adjacent immunocompetent cells, and vaginal epithelial cells. Insight into this cross talk during a pathogenic condition supports the treatment of vulvodynia with topical (compounded) creams. Vulvodynia was successfully treated with an analgesic cream consisting of baclofen 5% together with the autacoid palmitoylethanolamide 1% [Pea, PeaPure], an endogenous anti-inflammatory compound. In this review, data is presented to substantiate the rationale behind developing and prescribing topical products for localized pain states such as vulvodynia. Most chronic inflammatory disorders are based on a network pathogenesis, and monotherapeutic inroads into the treatment of such disorders are obsolete.

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[Vitalitus, the American manufacturer of PEA, expects to have their first batch of cream for sale in 2 weeks. It’s a 2% PEA cream.]

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The material on this site is for informational purposes only, and is not a substitute for medical advice,

diagnosis or treatment provided by a qualified health care provider.

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Dystonia with CRPS – Intrathecal Baclofen Training Needed


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People with Complex Regional Pain Syndrome (CRPS) may develop dystonia, which is a twisting, perhaps crushing, movement of the hands and feet, spine, muscles. That is called dystonia and there is a specific treatment: Baclofen given into the spinal fluid.

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All too often, people with CRPS encounter pain specialists who have little or no experience with CRPS, but they have been trained to do procedures: blocks, pumps, spinal cord stimulators. Doctors need to be trained how to diagnose dystonia and when to use a different type of pump.

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CRPS is different, and I suspect many doctors must not see enough cases to become familiar. I would plead for special education to train physicians — especially surgeons because trauma or surgery may trigger onset of this poorly understood syndrome. But we must train all PA’s, NP’s, PT’s, RN’s, pharmacists, all healthcare providers about CRPS.  For some, CRPS may be a life ending pain, and deserves early diagnosis and better treatment.

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There should be special centers for treatment of CRPS where patients are more likely to get best care and where research can be done.

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Treatment must be better than what I saw yesterday in a new patient who has been needlessly disabled for five years with crippling dystonia.

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Dystonia is treatable but was not diagnosed, despite many interventions, pumps, stims, blocks, repeated blocks, by teams of pain specialists and rehabilitation centers in Southern California and Georgia. Crippling dystonia was not recognized.

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Without centers for treatment of CRPS,

too many will not get the care needed to return to life.

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DYSTONIA EDUCATION NEEDED

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INTRATHECAL PUMPS

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Dystonia may occur in those with CRPS.

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I don’t follow the literature on pumps, but I have not seen anesthesia pain specialists or neurosurgeons doing intrathecal (IT) pumps since I left MD Anderson Cancer Center in 1994.

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Training to diagnose and treat dystonia should be in medical education programs, especially the interdisciplinary field of pain – a field that should not be left to the interventionists.

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The only treatment for the crippling, twisting movement disorder called dystonia is intrathecal baclofen, not oral. Baclofen must be pumped into the spinal fluid.

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I told my patient the diagnosis on the telephone before I saw him. Next, there is the fight to get insurance to allow referral to the neurosurgeon to co-manage that part of his care. We cannot say if he could have been back to work five years ago, only that twisting and crushing hands and feet can cause an agony on top of the pervasive burning.

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The gift of human life from better research and training in treatment of CRPS would be the best thing for productivity, health, and well being.

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Support better health care in this country so people don’t have to be disabled for decades with treatable conditions.

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And vote for your congressperson to support compounding pharmacies that are invaluable.

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It is an beyond belief that pain management is taught in only 3% of medical schools in 2016. We don’t need training in opioids. We need training in this vast field in every medical school. I’ll bet returning veterans have more CRPS than any other group. How many go unrecognized? How many doctors know what allodynia is?

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The material on this site is for informational purposes only.
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It is not legal for me to provide medical advice without an examination.

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It is not a substitute for medical advice, diagnosis or treatment provided

by a qualified health care provider.

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If you wish an appointment, please telephone the office to schedule.

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For My Home Page, click here:  Welcome to my Weblog on Pain Management!

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Vulvodynia & proctodynia treated with topical baclofen 5 % & palmitoylethanolamide


 

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Vulvodynia and proctodynia (rectal pain) treated with topical baclofen 5 % and palmitoylethanolamide

Abstract

Background

The prevalence of idiopathic vulvodynia and proctodynia is high. Pain management with anti-depressants and anti-epileptics may induce undesirable side effects. Therefore, topical baclofen cream and palmitoylethanolamide might be new therapeutic options.

Case

A 33-year-old woman with intractable chronic vulvar and anal pain had to abstain from sexual intercourse and could neither cycle nor sit for more than 5 min. The patient did not respond to standard treatments. We prescribed a combination of topical baclofen 5 % and palmitoylethanolamide 400 mg, three times daily. After 3 months her symptoms decreased more than 50 % and sexual intercourse was possible again without pain.

Conclusion

Topical baclofen and palmitoylethanolamide can be a viable treatment option in chronic vulvodynia and proctodynia.

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I have been very pleased with palmitoylethanolamide for neuropathic pain. It is made in the brain and by plants and I have never seen toxicity. PJ’s Prescription Shoppe imports it from the Netherlands for my patients, and it is available in a capsule as a food supplement called PeaPure, without prescription. I have posted on it and its mechanisms a few times elsewhere on this website.

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The material on this site is for informational purposes only.

It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

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For My Home Page, click here:  Welcome to my Weblog on Pain Management!

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