Tuesday, 19 November 2013

Enoxaparin Research Study - Summary and Review

Hey girls! As a psychology student, and consumed by the idea of vulvodynia, I do a lot of research in the subject! I haven’t posted any of the research I’ve found as of yet, but would like to start. Today I found a study on this drug called Enoxaparin. The study is called Enoxaparin Treatment for Vulvodynia A Randomized Controlled Trial by Yaniv Farajun, Doron Zarfati, Liora Abramov, Alejandro Livoff, and Jacob Bornstein. I’ll post the real citation underneath my summary of the article.

                The study recruited 40 women with severe localized provoked vulvodynia. They were randomly assigned to a placebo group or the Enoxaparin group. The women had to self-administer an injection every day (either 40mg of the Enoxaparin or a saline solution for placebo group) in the abdominal region, for 90 days. Women ALSO had to follow a low oxalate diet and take calcium citrate supplements (to give all clients a similar nutritional background – controls the variable of nutritional background).

The researchers hypothesized that Heparanase is a cause for an increase in neuron growth and neuron penetration in the vestibule which would vulvar sensitivity and pain. Enoxaparin may block the enzyme activity and inhibit the effects of the heparanase and so this study tests to see if Enoxaparin relieves any vulvodynia pain symptoms.

The Q-tip test was administered before treatment, with pain measures, and re-administered after the 90 days of treatment and then three months after completing the treatment. Participants kept a log book of side effects such as easy bruising, abnormal bleeding.

So what did they find? The Q-tip pain scores (scale 0-10), in the Enoxaparin group, reduced on average from 8.2/10 to 6.25/10 after treatment and 5.8/10 three months following treatment (a nice graph showing this on pg. 568 - figure two). Also, the women in the Enoxaparin group reported feeling less pain during intercourse by the end of treatment.

At the beginning of the study, women in the Enoxaparin group, had 15 women who could not have intercourse because it was too painful but by the end of the study, 20 women could not have intercourse because it was too painful (that doesn’t sound to promising!).

At the beginning of the study for the Enoxaparin group, 45 women had such intense pain they always had to stop mid intercourse and 40 women had intense pain but were able to complete intercourse with full penetration; by the end, these two categories decreased to 15 and 25 women (that’s a bit better).

And at the beginning of the study, zero women were under any of these three categories: almost painless intercourse, painless intercourse and not sexually active lately; by the end, these categories were filled with 35 women, no women and one woman.

But, the women in the placebo group showed a decrease in as well (although not as much)! There’s a detailed table showing everyone’s pain increases and decreases on pg. 570 in table five.

So there you go! Maybe Enoxaparin could be used as a treatment for women with localized provoked vulvodynia. It WILL NOT work for women with generalized and/or unprovoked vulvodynia treatment. The downfall to thus treatment: you have to inject yourself every day! And if you look the drug up, it’s got some not so nice side effects because its main use is to prevent Venous Thromboembolism type diseases.

There were a couple other things I didn’t like about this study, starting with the use of a low oxalate diet. I understand they wanted everyone to follow a similar diet to cancel out any external variables that could influence the treatment, but a low oxalate diet COULD affect treatment, because it is a treatment for some women! So it’s possible that some of the women (in either the control or the Enoxaparin groups) could have had symptom/pain relief not from the placebo or the Enoxaparin but from the low oxalate diet!

The other thing I didn’t like was that there was no mention of how many side effects were logged or called in.

Either way, I personally think, that this isn’t enough evidence (yet) to go out and ask for an Enoxaparin prescription. I’m sure further research will be done on the subject, and I would wait to see what those studies come up with for results first.

The proper citation for this article is:  Farajun, Y., Zarfati, D., Abramov, L., Livoff, A., & Bornstein, J. (2012). Enoxaparin treatment for vulvodynia: a randomized controlled trial. Obstetrics And Gynecology, 120(3), 565-572. doi:10.1097/AOG.0b013e3182657de6
And the article can be found for PDF download at: Link to site with PDF

If you guys have any questions about the study, about my summary, about any confusing terminology, etc. Leave a comment and I'll answer as best I can, ask someone who can or refer you to other resources.

I'm in my fourth year of a psychology program, so there are even some things in this study that I didn't quite understand, but what I've written for you guys above is the nitty gritty (the main important portions of the study that are important to an every day consumer). 

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