Vaginal pain, known as vulvodynia, is common in CFS and Fibromyalgia. Though it often improves over time by addressing with the overall "SHINE Protocol," medication is helpful for symptomatic relief. We begin by adding Neurontin and Elavil for sleep in those with Vulvodynia, but these sometimes cause unacceptable side effects. This new study showed that putting the Neurontin (Gabapentin) in a topical cream decreased pain by an average of 2/3, and decreased pain by over 50% in 80% of the women. The topical cream should be one that is not irritating when used vaginally. Ask the compounding pharmacist to also add Elavil to the cream for vulvodynia.
My book, Pain Free 1-2-3 discusses the use of topical pain meds as well as pelvic pain in depth. Topical pain meds allow high doses to get to your pain without side effects and at much lower cost. It is gratifying to see increasing awareness of this in the medical community. ITC Pharmacy makes several pain creams.
Obstetrics & Gynecology 2008;112:579-585
Topical Gabapentin in the Treatment of Localized and Generalized Vulvodynia
From the 1Department of Obstetrics and Gynecology, Women and Infants' Hospital of Rhode Island, the Warren Alpert Medical School of Brown University, Providence; and 2Pawtuxet Valley Prescription and Surgical Center, Inc., Coventry, Rhode Island.
To evaluate the clinical efficacy and tolerability of topical gabapentin in the treatment of women with vulvodynia.
A retrospective study was designed to ascertain clinical responses to topical gabapentin. Patient demographic and medical characteristics, including present and prior treatment for vulvodynia, were routinely collected. The final outcome was defined by a comparison between pretreatment and posttreatment mean pain scores based on a discrete visual analog scale of 0 to 10. Categorical data were compared by Fisher exact test, continuous variables between groups by the Wilcoxon rank sum test, and mean change in pain score between pretreatment and posttreatment by paired Student t test.
Between January 2001 and December 2006, 51 women with vulvodynia (19 or 37% with generalized vulvodynia, 32 or 63% with localized) were treated with 2% to 6% gabapentin. After a minimum of 8 weeks of therapy, the mean pain score among the 35 evaluable women was significantly reduced from 7.26 to 2.49 (mean change -4.77, 95% confidence interval -5.47 to -4.07). Overall, 28 of 35 (80%) demonstrated at least a 50% improvement in pain scores. Among patients with localized vulvodynia, sexual function improved in 17 of 20 with evaluable results (6 of 9 reinstituted vaginal intercourse, whereas all 11 patients experiencing decreased frequency of intercourse reported increased frequency after treatment). Discontinuations occurred in 7 of 50 (14%) treated.
Topical gabapentin seems to be well-tolerated and associated with significant pain relief in women with vulvodynia.
Jacob Teitelbaum, M.D. is one of the world's leading integrative medical authorities on fibromyalgia and chronic fatigue. He is the lead author of four research studies on their treatments, and has published numerous health & wellness books, including the bestseller on fibromyalgia From Fatigued to Fantastic! and The Fatigue and Fibromyalgia Solution. Dr. Teitelbaum is one of the most frequently quoted fibromyalgia experts in the world and appears often as a guest on news and talk shows nationwide including Good Morning America, The Dr. Oz Show, Oprah & Friends, CNN, and Fox News Health.