eISSN: 2719-9665
ISSN: 2719-5139
Physiotherapy Review
Current issue Archive Manuscripts accepted About the journal Editorial board Abstracting and indexing Subscription Contact Instructions for authors Ethical standards and procedures
Editorial System
Submit your Manuscript
vol. 28
Original paper

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

Weronika Solomon
1, 2
Elia Bassini
Sandra J. Hilton
Małgorzata Starzec-Proserpio

  1. Interdepartmental Centre for Research and Training (CIFAPPS), The Faculty of Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy
  2. Fisiomed, Studio di Fisioterapia, Adrano, Italy
  3. Entropy, Physiotherapy, United States
  4. Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
Physiotherapy Review, 2024, 28(1), 44-54
Online publish date: 2024/03/26
Article file
- art5_1-24-1.pdf  [0.23 MB]
Get citation
PlumX metrics:
1. Harlow BL, Stewart EG. A population-based assessment of chronic unexplained vulvar pain: have we underestimated the prevalence of vulvodynia? J Am Med Womens Assoc 1972. 2003; 58 (2): 82–88.
2. Bornstein J, Goldstein AT, Stockdale CK, Bergeron S, Pukall C, Zolnoun D, et al. 2015 ISSVD, ISSWSH, and IPPS Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia. J Sex Med. 2016; 13 (4): 607–612.
3. Falsetta ML, Foster DC, Bonham AD, Phipps RP. A review of the available clinical therapies for vulvodynia management and new data implicating proinflammatory mediators in pain elicitation. BJOG Int J Obstet Gynaecol. 2017; 124 (2): 210–218.
4. Goldstein AT, Pukall CF, Brown C, Bergeron S, Stein A, Kellogg-Spadt S. Vulvodynia: Assessment and Treatment. J Sex Med. 2016; 13 (4): 572–590.
5. Morin M, Binik YM, Bourbonnais D, Khalifé S, Ouellet S, Bergeron S. Heightened Pelvic Floor Muscle Tone and Altered Contractility in Women With Provoked Vestibulodynia. J Sex Med. 2017; 14 (4): 592–600.
6. Bergeron S, Reed BD, Wesselmann U, Bohm-Starke N. Vulvodynia. Nat Rev Dis Primer. 2020; 6 (1): 36.
7. Pukall CF, Goldstein AT, Bergeron S, Foster D, Stein A, Kellogg-Spadt S, et al. Vulvodynia: Definition, Prevalence, Impact, and Pathophysiological Factors. J Sex Med. 2016; 13 (3): 291–304.
8. Treede RD, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, et al. Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD11). PAIN. 2019; 160 (1): 19.
9. Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. The Revised IASP definition of pain: concepts, challenges, and compromises. Pain. 2020; 161 (9): 1976–1982.
10. Fitzcharles MA, Cohen SP, Clauw DJ, Littlejohn G, Usui C, Häuser W. Chronic primary musculoskeletal pain: a new concept of nonstructural regional pain. Pain Rep. 2022; 7 (5): e1024.
11. Terminology | International Association for the Study of Pain [Internet]. International Association for the Study of Pain (IASP). [cited 2023 Oct 4]. Available from: https://www.iasp-pain.org/resources/terminology/
12. Bohm-Starke N. Medical and physical predictors of localized provoked vulvodynia. Acta Obstet Gynecol Scand. 2010; 89 (12): 1504–1510.
13. Zhang Z, Zolnoun DA, Francisco EM, Holden JK, Dennis RG, Tommerdahl M. Altered central sensitization in subgroups of women with vulvodynia. Clin J Pain. 2011; 27 (9): 755–763.
14. Harte SE, Harris RE, Clauw DJ. The neurobiology of central sensitization. J Appl Biobehav Res. 2018; 23 (2): e12137.
15. Till SR, Nakamura R, Schrepf A, As-Sanie S. Approach to Diagnosis and Management of Chronic Pelvic Pain in Women: Incorporating Chronic Overlapping Pain Conditions in Assessment and Management. Obstet Gynecol Clin North Am. 2022; 49 (2): 219–239.
16. Kumar R, Scott K. Chronic Pelvic Pain and the Chronic Overlapping Pain Conditions in Women. Curr Phys Med Rehabil Rep. 2020; 8 (3): 207–216.
17. Lin I, Wiles L, Waller R, Goucke R, Nagree Y, Gibberd M, et al. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med. 2020; 54 (2): 79–86.
18. Ferraz MB, Quaresma MR, Aquino LR, Atra E, Tugwell P, Goldsmith CH. Reliability of pain scales in the assessment of literate and illiterate patients with rheumatoid arthritis. J Rheumatol. 1990; 17 (8): 1022–1024.
19. Frawley H, Shelly B, Morin M, Bernard S, Bø K, Digesu GA, et al. An International Continence Society (ICS) report on the terminology for pelvic floor muscle assessment. Neurourol Urodyn. 2021; 40 (5): 1217–1260.
20. Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine. 2000; 25 (22): 2940–2952; discussion 2952. 53 Physiotherapy Review | Volume XXVIII Issue 1/2024
21. Dermo Neuro Modulating: Manual Treatment for Peripheral Nerves and Especially Cutaneous Nerves - Kindle edition by Jacobs, Diane. Health, Fitness & Dieting Kindle eBooks @ Amazon.com. [Internet]. [cited 2023 Oct 4]. Available from: https://www.amazon.com/dp/B01N0J8HVO?s=- books&ie=UTF8&qid=1480126884&sr=1-3&keywords=Diane+Jacobs&linkCode=sl1&tag=dpamazon02-20&linkId=c099d4615e7f56477eb11034cb5dba70&language=en_US&ref_=as_li_ss_tl
22. Self-Care for Pelvic Pain: A Sensory Integration Toolkit | OPTP [Internet]. [cited 2023 Oct 4]. Available from: https://www.optp.com/Self-Care-forPelvic-Pain-A-Sensory-Integration-Toolkit
23. Louw A, Hilton S, Vandyken C. Why Pelvic Pain Hurts - Neuroscience Education for Patients with Pelvic Pain: Neuroscience Education for Patients with Pelvic Pain. Orthopedic Physical Therapy Products; 2015.
24. Vandyken C, Hilton S. Physical Therapy in the Treatment of Central Pain Mechanisms for Female Sexual Pain. Sex Med Rev. 2017; 5 (1): 20–30.
25. Dworkin RH, Turk DC, Wyrwich KW, Beaton D, Cleeland CS, Farrar JT, et al. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. J Pain. 2008; 9 (2): 105–121.
26. Ostelo RWJG, Deyo RA, Stratford P, Waddell G, Croft P, Von Korff M, et al. Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine. 2008; 33 (1): 90–94.
27. Hutting N, Caneiro JP, Ong’wen OM, Miciak M, Roberts L. Person-centered care for musculoskeletal pain: Putting principles into practice. Musculoskelet Sci Pract. 2022; 62: 102663.
28. Kent P, Haines T, O’Sullivan P, Smith A, Campbell A, Schutze R, et al. Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain (RESTORE): a randomised, controlled, three-arm, parallel group, phase 3, clinical trial. The Lancet. 2023; 401 (10391): 1866–1877.
29. O’Sullivan PB, Caneiro JP, O’Keeffe M, Smith A, Dankaerts W, Fersum K, et al. Cognitive Functional Therapy: An Integrated Behavioral Approach for the Targeted Management of Disabling Low Back Pain. Phys Ther. 2018; 98 (5): 408–423.
30. Nicholas MK, George SZ. Psychologically informed interventions for low back pain: an update for physical therapists. Phys Ther. 2011; 91 (5): 765–776.
31. Main CJ, George SZ. Psychologically informed practice for management of low back pain: future directions in practice and research. Phys Ther. 2011; 91 (5): 820–824.
32. Lamvu G, Carrillo J, Ouyang C, Rapkin A. Chronic Pelvic Pain in Women: A Review. JAMA. 2021; 325 (23): 2381–2391.
33. Ariza-Mateos MJ, Cabrera-Martos I, Ortiz-Rubio A, Torres-Sánchez I, Rodríguez-Torres J, Valenza MC. Effects of a Patient-Centered Graded Exposure Intervention Added to Manual Therapy for Women With Chronic Pelvic Pain: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2019; 100 (1): 9–16.
34. Ariza-Mateos MJ, Cabrera-Martos I, López-López L, Rodríguez-Torres J, Torres-Sánchez I, Valenza MC. Effects of a patient-centered program including the cumulative-complexity model in women with chronic pelvic pain: a randomized controlled trial. Maturitas. 2020; 137: 18–23.
35. Haugstad GK, Haugstad TS, Kirste UM, Leganger S, Klemmetsen I, Malt UF. Mensendieck somatocognitive therapy as treatment approach to chronic pelvic pain: results of a randomized controlled intervention study. Am J Obstet Gynecol. 2006; 194 (5): 1303–1310.
36. Hess Engström A, Bohm-Starke N, Kullinger M, Hesselman S, Högberg U, Buhrman M, et al. Internet-based Treatment for Vulvodynia (EMBLA) - A Randomized Controlled Study. J Sex Med. 2022; 19 (2): 319–330.
37. Cohen SP, Vase L, Hooten WM. Chronic pain: an update on burden, best practices, and new advances. The Lancet. 2021; 397 (10289): 2082–2097. 54 Physiotherapy Review | Volume XXVIII Issue 1/2024
38. Bardin M, Brassard A, Dumoulin C, Bergeron S, Mayrand M, Waddell G, et al. 014 Examining the Role of the Physical Therapist in Treatment Response of Provoked Vestibulodynia. J Sex Med. 2019; 16 (Supplement_3): S7.
39. Shared decision making | NICE guidelines | NICE guidance | Our programmes | What we do | About [Internet]. NICE. NICE; [cited 2023 Oct 4]. Available from: https://www.nice.org.uk/about/what-wedo/our-programmes/nice-guidance/nice-guidelines/shared-decision-making
40. Louw A, Zimney K, O’Hotto C, Hilton S. The clinical application of teaching people about pain. Physiother Theory Pract. 2016; 32 (5): 385–395.
41. Toye F, Belton J, Hannink E, Seers K, Barker K. A Healing Journey with Chronic Pain: A Meta-Ethnography Synthesizing 195 Qualitative Studies. Pain Med Malden Mass. 2021; 22 (6): 1333–1344.
42. Belton J. Exploring the Meanings of Pain: My Pain Story. In: van Rysewyk S, editor. Meanings of Pain: Volume 2: Common Types of Pain and Language [Internet]. Cham: Springer International Publishing; 2019 [cited 2023 Oct 4]. p. 1–15. Available from: https://doi.org/10.1007/978-3-030-24154-4_1
43. Miciak M, Mayan M, Brown C, Joyce AS, Gross DP. The necessary conditions of engagement for the therapeutic relationship in physiotherapy: an interpretive description study. Arch Physiother. 2018; 8: 3.
44. Denneny D, Frawley HC, Petersen K, McLoughlin R, Brook S, Hassan S, et al. Trigger Point Manual Therapy for the Treatment of Chronic Noncancer Pain in Adults: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil. 2019; 100 (3): 562–577.
45. Bélanger C, Dumoulin C, Bergeron S, Mayrand MH, Khalifée S, Waddell G, et al. Pain Characteristics, Fear-avoidance Variables, and Pelvic Floor Function as Predictors of Treatment Response to Physical Therapy in Women With Provoked Vestibulodynia. Clin J Pain. 2022; 38 (5): 360–367.
46. Hohenschurz-Schmidt D, Thomson OP, Rossettini G, Miciak M, Newell D, Roberts L, et al. Avoiding nocebo and other undesirable effects in chiropractic, osteopathy and physiotherapy: An invitation to reflect. Musculoskelet Sci Pract. 2022; 62: 102677.
47. Rossettini G, Colombi A, Carlino E, Manoni M, Mirandola M, Polli A, et al. Unraveling Negative Expectations and Nocebo-Related Effects in Musculoskeletal Pain. Front Psychol. 2022; 13: 789377.
48. Tikac G, Unal A, Altug F. Regular exercise improves the levels of self-efficacy, self-esteem and body awareness of young adults. J Sports Med Phys Fitness. 2022; 62 (1): 157–161.
49. Sluka KA, Law LF, Bement MH. Exercise-induced pain and analgesia? Underlying mechanisms and clinical translation. Pain. 2018; 159 (Suppl 1): S91–97.
50. Beserra AHN, Kameda P, Deslandes AC, Schuch FB, Laks J, Moraes HS de. Can physical exercise modulate cortisol level in subjects with depression? A systematic review and meta-analysis. Trends Psychiatry Psychother. 2018; 40 (4): 360–368.
51. Torres-Cueco R, Nohales-Alfonso F. Vulvodynia-It Is Time to Accept a New Understanding from a Neurobiological Perspective. Int J Environ Res Public Health. 2021; 18 (12): 6639.
52. Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977; 196 (4286): 129–136.
53. Mardon AK, Leake HB, Szeto K, Astill T, Hilton S, Moseley GL, et al. Treatment recommendations for the management of persistent pelvic pain: a systematic review of international clinical practice guidelines. BJOG Int J Obstet Gynaecol. 2022; 129 (8): 1248–1260.
54. Alexanders J, Anderson A, Henderson S. Musculoskeletal physiotherapists’ use of psychological interventions: a systematic review of therapists’ perceptions and practice. Physiotherapy. 2015; 101 (2): 95–102.

Quick links
© 2024 Termedia Sp. z o.o.
Developed by Bentus.