New Treatment For Vulvodynia – 6% Gabapentin in Lipoderm

6% Gapapentin in Lipoderm is helpful in vulodynia. Interesting how they made it up.

Obstet Gynecol. 2008 Sep;112(3):579-85.
Topical gabapentin in the treatment of localized and generalized vulvodynia.
Boardman LA, Cooper AS, Blais LR, Raker CA.

abstract

• Lifelong accumulative incidence 15%
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  “gabapentin cream by dissolving gabapentin powder in ethoxy diglycol, then levigating the mixture into PCCA Lipoderm base (PCCA, Houston, TX), an enhanced base which facilitates tissue penetration, and placing the final product in plastic tubes for dispensation.”

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  They tried varying strengths 2% to start to check for irritation and work up to 6% apply the size of a pea TID (3X/day)- after 90 days still 93% bioavailablity.

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  Older, previous childern and hysterectomy history are risk factors for generalized form

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  14% discontinued because of irritation or urinary symptoms

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  80% at least 50% improvement and 29% complete relief after 8 weeks

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  localized forms dropped from average 7.9/10 to 2.7; generalized from 5.8 to 2.0

Other agents have been used:

1) Lidocaine 5%:

Zolnoun, Denniz A; Hartmann, Katherine E; Steege, John F.
Overnight 5% lidocaine ointment for treatment of vulvar vestibulitis.
Obstetrics & Gynecology. 102(1):84-7, 2003 Jul.

“Patients were instructed to apply a copious amount of 5% lidocaine ointment to the affected area at bedtime and were asked to place a cotton ball generously coated with the 5% lidocaine ointment in the vestibule to assure continuing overnight application. We instructed patients to use the treatment nightly, for 8 or more hours.”

VAS pain fell from 2.7/10 to 1.7 though pain with intercourse fell from 7.6/10 to 3.7

Decline in VAS was not great but neither was pain to start with – so hard to compare both trials.

2) Nitorglycerin

J Gend Specif Med. 2002 Jul-Aug;5(4):21-7.

Safety and efficacy of topical nitroglycerin for treatment of vulvar pain in
women with vulvodynia: a pilot study.Walsh KE, Berman JR, Berman LA, Vierregger K.
abstract

0.2% cream at least 3 times week 5-10 minutes prior to intercourse

0.2% cream at least 3 times week 5-10 minutes prior to intercoursepain improved from 7.9/10 to 5.1; with sex 7.3/10 to 4.3

one would have thought more regular use more beneficial… Headaches has got to be an issue though regular use could relieve that.

3) Capsaicin 0.025% in acid mantle cream (chosen because it is alcohol free). 2% lidocaine gel was put one for 10 minutes prior to capsaicin. done once daily for 20 minutes for 12 weeks

– reduced touch test results to 1/3rd

Interested in any experience with that…