The role of immunoenzymatic therapy in the management of vestibulodynia associated with painful bladder syndrome

Filippo Murina, Raffaele Felice, Stefania Di Francesco, Valeria Mantegazza

Outpatient Department of Vulvar Disease, V. Buzzi Hospital-University of Milan, Milan, Italy.

DOI: 10.4236/ojog.2013.34A003                

Abstract

Background: Vestibulodynia (VBD) and painful bladder syndrome (PBS) are two common and often concomitant conditions. Objective: To assess the effectiveness of an enzymatic combination of papain, bromelain, trypsin, chymotrypsin and quercetin in the supportive treatment of VBD/PBS, patients underwent TENS + amitriptyline and pregabalin therapy as a multimodal treatment strategy. Method: 40 patients were randomly assigned to receive a systemic therapy: amitriptyline + pregabalin (Group A) versus amitriptyline + Pregabalin plus a systemic enzyme preparation (Group B). All patients received a transcutaneous electric nerve stimulation (TENS) therapy in a self-administered domiciliary protocol. Results: The VAS and the dyspareunia score after the treatment showed a significant difference in the two groups (VAS: Group A difference of 4.3, Group B difference of 3.1, p = 0.005; dyspareunia: Group A and Group B 1.8 vs. 0.8, p = 0.005). Conclusion: The positive results of our study prove the utility effectiveness of an enzyme combination to decrease and normalize the biomarkers of inflammation in VBD and PBS patients in a multimodal approach.

Keywords

Vulvodynia; TENS; Vulvar Vestibulitis Syndrome; Painful Bladder Syndrome; Immunoenzymatic Therapy

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Moyal-Barracco, M. and Lynch, P.J. (2004) ISSVD terminology and classification of vulvodynia: A historical perspective. The Journal of Reproductive Medicine, 49, 772-777.
[2]	Haefner, H.K., Collins, M.E., Davis, G.D., Edwards, L., Foster, D.C., Hartmann, E.D., et al. (2005) The vulvodynia guideline. Journal of Lower Genital Tract Disease, 9, 40-51. doi:10.1097/00128360-200501000-00009
[3]	Butrick, C.W. (2003) Interstitial cystitis and chronic pelvic pain: New insights in neuropathology, diagnosis, and treatment. Clinical Obstetrics and Gynecology, 46, 811-823. doi:10.1097/00003081-200312000-00011
[4]	Van de Merwe, J.P., Nordling, J., Bouchelouche, P., et al. (2007) Diagnostic criteria, classification, and nomenclature for painful bladder syndrome/interstitial cystitis: An ESSIC proposal. European Urology, 53, 60-67.
[5]	Mccormack, W.M. (1990) Two urogenital sinus syndromes: Interstitial cystitis and focal vulvitis. The Journal of Reproductive Medicine, 35, 873-876.
[6]	Peters, K., Girdler, B., Carrico, D., et al. (2008) Painful bladder syndrome/interstitial cystitis and vulvodynia: A clinical correlation. International Urogynecology Journal and Pelvic Floor Dysfunction, 19, 665-669.
[7]	Myers, D.L. and Aguilar, V.C. (2002) Gynecologic manifestations of interstitial cystitis. Clinical Obstetrics and Gynecology, 45, 233-241. doi:10.1097/00003081-200203000-00024
[8]	Bornstein, J., Goldschmid, N. and Sabo, E. (2004) Hyperinnervation and mast cell activation may be used as histopathologic diagnostic criteria for vulvar vestibulitis. Gynecologic and Obstetric Investigation, 58, 171-178. doi:10.1159/000079663
[9]	Metts, J.F. (2001) Interstitial cystitis: Urgency and frequency syndrome. American Family Physician, 64, 1199-1206.
[10]	Friedrich Jr., E.G. (1987) Vulvar vestibulitis syndrome. The Journal of Reproductive Medicine, 32, 110-114.
[11]	Marinoff, S.C. and Turner, M.L.C. (1992) Vulvar vestibulitis syndrome. Dermatologic Clinics, 10, 435-444.
[12]	Murina, F., Bianco, V., Radici, G., Felice, R., Di Martino, M. and Nicolini, U. (2008) Transcutaneous electrical nerve stimulation to treat vestibulodynia: A randomized controlled trail. BJOG: An International Journal of Obstetrics & Gynaecology, 115, 1165-1170. doi:10.1111/j.1471-0528.2008.01803.x
[13]	Paxton, S. (1980) Clinical use of TENS: A survey of physical therapists. Physical Therapy, 60, 38-44.
[14]	Robinson, A.J. and Snyder-Mackler, L., Eds. (2008) Clinical electrophysiology. Lippincott Williams & Wilkins, Philadelphia, 107-149.
[15]	Lauer, D., Reichenbach, A. and Birkenmeier, G. (2001) Alpha 2-macroglobulin-mediated degradation of amyloid beta 1-42: A mechanism to enhance amyloid beta catabolism. Experimental Neurology, 167, 385-392. doi:10.1006/exnr.2000.7569
[16]	Mettenburg, J.M. and Gonias, S.L. (2005) Beta-amyloid peptide binds equivalently to binary and ternary alpha2-macroglobulin-protease complexes. The Protein Journal, 24, 89-93. doi:10.1007/s10930-004-1515-7
[17]	Kandere-Grzybowska, K., et al. (2006) Regulation of IL-1-induced selective IL-6 release from human mast cells and inhibition by quercetin. British Journal of Pharmacology, 148, 208-215. doi:10.1038/sj.bjp.0706695