Experience with nutraceutical supplements in the treatment of pelvic pain in gynaecology: case reports
Three women with diverse gynaecological medical histories (one with endometriosis, one having had an episiotomy and obstetric anal sphincter injury during a recent delivery, and one having had a recent cystectomy of the left Bartholin gland) developed acute episodes of gynaecological pelvic pain. In each case, clinical investigations (including objective tools for assessing the source, nature and severity of the pain) were conducted early on, and a multimodal approach to therapy was introduced to control the pain and avoid central sensitization or chronicity. The multimodal approach included hormone therapy, antineuropathic medications, and corticosteroid or botulinum neurotoxin infiltrations in some of the patients according to their medical conditions but consistently included behavioural adjustments, physical interventions and a nutraceutical supplement (alpha-lipoic acid, palmitoylethanolamide and myrrh). In each case, the pelvic pain and associated dyspareunia (Marinoff scale 2 or 3) were largely resolved. These clinical cases support the results of clinical trials showing the benefits of alpha-lipoic acid + palmitoylethanolamide + myrrh for the management of gynaecological pelvic pain, enabling the reduction or withdrawal of other analgesic, anti-inflammatory and antineuropathic medications.