When the pain does not go away – a case report on a comprehensive biopsychosocial physiotherapy approach for refractory vulvodynia treatment

Background
Vulvodynia is a chronic primary pain condition marked by persistent vulvar pain lasting more than three months, often accompanied by various potential contributing factors. Traditionally, it has been misunderstood as either solely a physical or psychological disorder. However, contemporary recommendations for managing persistent pain underscore the necessity of adopting a broader, patient-centered approach that extends beyond the conventional biomedical model.

Aims
This case report aims to illustrate a comprehensive, biopsychosocial physiotherapy approach designed for the treatment of refractory vulvodynia. Case report: A 28-year-old woman sought help at the physiotherapy clinic, presenting with refractory vulvodynia and concurrent low back pain. Previous biomedically-focused interventions, including surgery, had proven ineffective. The presented physiotherapy approach centered on central pain mechanisms and encompassed patient-centered, values-based goals, pain neuroscience education, as well as local and global gentle manual therapy techniques and therapeutic exercises. The Numerical Pain Rating Scale (NRPS) gauged pain levels during the cotton-swab test (vestibular allodynia) and pelvic floor palpation. Additional outcomes were assessed through the Oswestry Low Back Pain Disability Questionnaire (ODI). Pre and post-treatment evaluations were conducted over a 10-week period. Following the completion of 10 weekly sessions, pain during the cotton-swab test and pelvic floor palpation diminished from 8 to 2 points on the NRPS. ODI scores decreased from 9 to 3 points. These changes exceeded the minimal clinically important change estimated for the utilized outcome measures. Subsequently, the patient was able to resume activities that had previously been compromised by her pain.

Summary
Physiotherapy within the biopsychosocial framework emerges as a promising treatment avenue for women grappling with refractory vulvodynia. Further research to assess the effectiveness of this approach is warranted.