• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • #GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • 0 CME Hours
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • #GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
#Grand Rounds

Is Gabapentin an Effective First Line Drug for Vulvodynia?

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE: 

  • A few previous RCTs that assessed the use of gabapentin to treat vulvodynia did not show benefit; however, studies had design limitations  
  • Despite lack of evidence, gabapentin is in use for this indication and appears in some guidelines on this topic   
  • Brown et al. (Obstetrics & Gynecology 2018) sought to determine the efficacy of extended-release gabapentin in the treatment of localized provoked vulvodynia (previously known as vulvar vestibulitis) 

METHODS: 

  • Multicenter double-blind, placebo-controlled randomized crossover trial (RCT) 
  • Participants
    • 18-50 years (later extended to >50) 
    • 3 continuous mounts of insertional dyspareunia  
    • Pain to vulvar touch and/or tampon insertion during pelvic exam  
  • Patients received either
    • Gabapentin (1,200-3,000 mg/d)  
    • Placebo 
  • 8 phase protocol  
    • 2-week screening phase | randomization | 4-week dose titration | 2-week maintenance phase | 2-week dose taper | 4-week dose titration after crossover | 2-week postcrossover maintenance | 2-week dose taper phase with scheduled visits at 6, 8, 14, and 16 weeks 
  • Tampon pain test 
    • Validated 11-point numeric rating scale ranging from 0 (no pain) to 10 (worst pain) 
  • Sexual intercourse and daily pain were also recorded on an 11 point (0-10) numeric rating scale  
  • Primary outcome:  
    • Mean pain intensity on the tampon test (tampon insertion and removal test used as a surrogate marker for dyspareunia) during the last 7 days of the maintenance phase  
  • Secondary outcomes  
    • Sexual intercourse pain and daily pain

RESULTS: 

  • 89 women participants were randomized  
  • There was no difference in tampon test pain with gabapentin vs placebo (P=.07) 
    • Adjusted mean 4.0 vs 4.3; difference −0.3 (95% CI −0.7 to 0.0) 
  • Similarly, there was no improvement with gabapentin vs placebo for  
    • Sexual intercourse pain (P=.76)  
    • Daily pain (P=.36) 
  • Subset analyses found that longer pain duration and oral contraceptive nonuse were associated with minimal improvement in tampon test pain with gabapentin 

CONCLUSION: 

  • Gabapentin did not reduce tampon test pain, compared to placebo 
  • The authors state  

Because previous RCTs studying pharmacologic management options also have been negative, practitioners may want to consider all therapeutic options, including nonpharmacologic management interventions such as physical therapy and behavioral and sexual counseling. 

Learn More – Primary Sources: 

Gabapentin for the Treatment of Vulvodynia: A Randomized Controlled Trial 

image_pdfFavoriteLoadingFavorite

< Previous
All #Grand Rounds Posts
Next >

Related ObG Topics:

Evaluating Vulvodynia – Making the Diagnosis and Key Management Points
Is Catechol-O-Methyltransferase a Cause of Pain in Vulvodynia?
Pelvic Floor Physical Therapy – PFPT and When to Use it

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • #Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

ObG Library

  • Hysteroscopy
  • Fertility
  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Get Guideline Alerts Direct to Your Phone
Try ObGFirst Free!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Log In to ObG First

Please log in to access OBGFirst and the 2T Ultrasound Atlas

Password Trouble?

Sign Up for ObGFirst

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!

ObG First Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site