(069) LOW-INTENSITY SHOCK WAVES PLUS TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION THERAPY IN WOMEN WITH VULVODYNIA
Authors: Solano Sanchez SR 
Published: December 2024

Abstract

Introduction
Vulvodynia is a vulvar pain of at least 3 months of duration, without a clear identifiable cause, which may have potential associated factors. While current treatments have limited effectiveness, Low-Intensity Shockwave Therapy (LiSWT) has shown promise in managing chronic pelvic pain.

Objective
This study aims to evaluate the effectiveness of combining LiSWT with Transcutaneous Electrical Nerve Stimulation (TENS) in treating vulvodynia.

Methods
Conducted within a hospital’s Urogynecology department, this intragroup clinical trial represents a secondary analysis within a broader LiSWT research framework. Participants included women with vulvodynia history. Exclusion criteria: Neurological or psychiatric disease history, pregnancy, pelvic organ prolapse stage III-IV, uterine or adnexal pathology. The trial aimed to recruit seventeen women, determined through a sample size calculation for detecting significant differences in continuous variables using a T-test. Ethical approval was granted for the study. All women underwent an urogynecological physical examination. It was evaluated the anatomical points established by the POP-Q system and ultrasound with multifrequency endovaginal transducer. Additionally, 23 women underwent an urodynamics evaluation. The treatment protocol consisted of twelve sessions, one per week for 45 minutes, combining TENS applied via a perineal patch with LiSWT directed abdominally, delivering 1000 shock waves per session. This last protocol consists in four sessions (1 per week); 2 weeks off and four additional sessions using Medispec ED-1000. Vulvodynia was evaluated before and after treatment with “Visual analog scale” (VAS).

Results
The study included thirty women, though one participant was subsequently excluded due to a psychiatric condition. The average age of participants was 44 years, with an average duration of vulvodynia symptoms of 3.8 years. Urodynamic studies revealed that 48% of the participants experienced voiding dysfunction, and 24% displayed detrusor overactivity. Notably, pelvic floor overactivity was identified in 87% of the women who underwent urodynamic evaluation. Pain levels were quantitatively assessed using VAS before and after the treatment intervention. Statistical analysis showed a significant reduction in pain scores, with the mean pain score decreasing from 9.3 before treatment to 0.83 after treatment. This difference is statistically significant.

Conclusions
Vulvodynia can cause severe chronic pain and has an elusive and multifactorial etiology. There are many hypotheses like hormonal, genetic, autoimmune, neuropathic, psychosomatic factors, and pelvic floor overactivity, which was prominently observed in this study. The mechanism of action for LiSWT includes improvements in circulation, recruitment and activation of stem cells, immune regulation, reduction of fibrosis, and nerve repair. Additionally, a neuromuscular effect has been proposed to contribute to its efficacy. Our findings suggest that combining LiSWT with TENS is effective in alleviating pain for women suffering from vulvodynia. This combination therapy holds significant promise for advancing treatment within the field of urogynecology, offering a robust alternative to traditional treatment methods. Further research through double-blind studies is needed to substantiate these findings.

Disclosure
No.