Analgesic therapy, which involves blocking nerve centers by local infiltration of anesthetic drugs, is often the key to defeating pain caused by vulvidinia when traditional therapies are insufficient or provide only temporary relief. It is a strategy that requires minimally invasive treatment and over time helps reprogram the brain and pain circuits . Let’s understand more about it.
The theory of “brain resetting”
For years, local anesthetics (such as those used by the dentist) were thought to have only a transient effect: they “numb” the nerve giving immediate but short-lived relief. The “brain resetting” theory, on the other hand, is based on the idea that the drug should not only anesthetize the symptom, but “reprogram” the brain, that is, periodically, at regular intervals, numbing the painful nerve structures to gradually “teach” the brain to stop caring.
“This type of analgesic therapy is based on long clinical experience, and the benefits have been confirmed by neuroscience,” explains Ezio Vincenti, anesthesiologist, freelancer in Padua, Italy, and director emeritus at the Department of Surgery in Dolo, Venice.“Studies with functional magnetic resonance imaging show that people with chronic pain have amore extensive and active pain brain reae. In the case of vulvodinia, free peripheral endings of pain fibers have been shown to be more arborized and more superficial than normal. This underlies allodynia and hyperalgeia, i.e., increased sensitivity to peripheral stimulation: pain is more easily produced because there is a denser and “surfacing” network of nerve endings capable of sending nociceptive signals to the brain.”
Turning off the warning signal
Continues the expert, “It is assumed that the brain needs this dense nerve network in the periphery to better control thealarm situation that has been created: it is as if, in a crisis area, an armed army should be sent to control the territory and prevent attacks. But if, after a while, you observe that the situation in that area is no longer dangerous, you can consider withdrawing troops.
Similarly, periodic, repeated infiltrations of the anesthetic gradually “turns off” the pain signal that reaches the brain, which, no longer receiving alarm messages from that area, understands that the danger has ceased. Once tranquilized by the periodic implementation of peripheral blocks, the brain, thanks to its ability to modify itself (neuroplasticity), “resets,” reducing alarm areas. Progressively, peripheral nerve endings become less superficial and reduce in number, returning to normal lity.Thus the woman returns to normal sensitivity, feeling pain only when there is a reason (for example, an injury).”
Anesthetics: not just “pain silencers”
This theory assumes that the anesthetic drug, contrary to the common opinion that circumscribes its effect in its immediacy, exerts a wide range of therapeutic actions, which may be expressed simultaneously with the local anesthetic action, for example, antinociceptive, anti-inflammatory, but also antioxidant and antimicrobial. As for the active ingredient to be used, there is a wide range of choice. “My preference for this type of analgesic therapy was to the racemic bupivacaine solution, whose chemical conformation offers high anesthetic potency,” Vincenti explains. “In addition, it boasts a longer shelf life than other starches and has several properties, for example, antimicrobial.”
Analgesic therapy: the treatment and benefits of infiltration
Infiltrations are performed by an anesthesiologist experienced in analgesic therapy. The main nerve center blocks used for chronic pelvic pain are: the impari ganglion block, which works on the vegetative component of pain, often associated with burning sensation; the sacral root block, which works on the nerve roots that carry pain; and the pudendal nerve block, crucial for relieving vulvo-vaginal and perineal neuropathic pain.
Generally, during the first session, pain relief lasts from a few hours to about 24 hours. Thereafter, with repeated blocking of nerve centers (performed every 3-4 weeks), the pain-free interval gradually increases. In addition, when it returns, the pain is usually more relieved. Within 5-6 months, in 8 out of 10 women, the pain symptoms disappear or subside noticeably, but the timing is very subjective. When the results of antalgic therapy become apparent,supportive drugtherapy is also generally revised, gradually reducing it until it is discontinued.
Roberta Camisasca
