The Use of an Acupuncture Point Protocol incorporating Electroacupuncture in the Treatment of Patients with Vulvodynia. A Case Series of Eight Patients Background
By Fiona MacQueen
Vulvodynia is a chronic pain disorder with an estimated incidence of 9-12%. The International Society for the Study of Vulvovaginal Disease (2003) define it as vulvar discomfort, most often described as burning pain, occurring in the absence of relevant visible findings or a specific, clinically identifiable, neurological disorder. Pathogenesis may be multifactorial and as such it is a difficult condition to treat, often multi-disciplinary, involving combinations of therapy.
To explore the usefulness of a predetermined acupuncture protocol as an adjunct or perhaps alternative to usual treatments for the condition. Rationale Previous studies of acupuncture have shown a degree of benefit which is sustained for some time, suggesting that acupuncture may be beneficial for this condition. An acupuncture point protocol was developed, based on Western Medicine (WM) theory, for ease of use by different practitioners within the pain clinic setting.
Eight patients received acupuncture, incorporating electroacupuncture, at selected points based on the segmental innervation of the vulva. The patients were studied in a ‘real case scenario’ where some were taking medication, but it was not fully controlling their symptoms. Prior to starting treatment, patients completed a Numerical Rating (pain) Score (NRS) and a Quality of Life (QOL) Score. This was repeated one week and three months after the last treatment. At this time a single ‘top-up’ treatment was offered, timed to coincide with the normal top-up treatment offered in the NHS Pain Clinic. If shown to be helpful, the treatment could be protocolised and used within other pain clinic settings. The protocol stated that each patient would have six treatments one week apart.
Due to the small number of participants no statistical analysis was performed. One patient reported temporary worsening of pain and withdrew. Two patients showed no response. The remaining five patients reported an improvement in pain and Qaulity of Life scores during and for a few weeks after completing the treatment. However in only one patient was the benefit maintained at the twelve week follow-up.
The observed effects were clinically comparable with those of some other studies. Overall the patients reported a positive experience. The study concluded that acupuncture could be helpful in the management of vulvodynia. However, no conclusions could be drawn regarding efficacy as numbers were too small. In this group of patients benefit was mostly short-term, although in accordance with clinical experience. Ideally, treatments should be provided on a monthly basis in order to maintain benefit. Further study would be required to ascertain superiority of electroacupuncture in the treatment of this condition.