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We evaluated the efficacy of gabapentin, in an extended release formulation, in women diagnosed with localized provoked vulvodynia, defined as superficial vulvar vestibular pain that is provoked by touch, in a demographically diverse sample. Pelvic floor hypertonicity and vulvodynia are frequently present concomitantly. 31,32 Baclofen’s muscle relaxation actions and decreased adverse effect profile make it a feasible treatment option. 33,34 One study found baclofen an effective treatment when combined in a cream with amitriptyline. 27 Additionally, a case report used a compounded In a retrospective chart review, 28 gabapentin cream reduced vulvar pain in PV and generalized vulvodynia pre‐ to post‐treatment. Gabapentin cream must be obtained through a compounding pharmacy. Efficacy of gabapentin cream needs to be tested in future RCTs. Study Selection and Data Extraction: This review includes articles in the English language and human trial literature. Twenty-five trials explored the use of oral and topical medications in the treatment of vulvodynia. Data Synthesis: Vulvodynia is a poorly understood disease with an unknown etiology. Oral tricyclic antidepressants and 2–6% topical cream, 8 weeks: Gabapentin: Highest tolerable oral dose between 1200 and 3000 mg per day for 8 weeks: Oral gabapentin, 1200–3000 mg per day for 8 weeks: Anti-inflammatory agents: Submucosal methylprednisolone (1, 0.5, 0.3 mL) once per week for 3 weeks: Corticosteroids Ben-David B, Friedman, M. Gabapentin therapy for vulvodynia. Anesth Anal. 1999;89:1459-1462. Harris G, Horowitz B, Borgida A. Evaluation of gabapentin in the treatment of generalized vulvodynia, unprovoked. J Reprod Med. 2007; 52:103. Andrews JC. Vulvodynia interventions- systematic review and evidence grading. Obstet Gynecol Survey. 2011:66(5 Results: 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 Topical gabapentin 6% cream. Researchers evaluated the clinical efficacy and tolerability of topical gabapentin 6% cream, and found that after a minimum of 8 weeks of therapy, pain was significantly reduced and sexual function improved. In a retrospective chart review, 28 gabapentin cream reduced vulvar pain in PV and generalized vulvodynia pre- to post-treatment. Gabapentin cream must be obtained through a compounding pharmacy. Efficacy of gabapentin cream needs to be tested in future RCTs. Gabapentin 1%, 5%, 10% Cream or Gel. Gabapentin topical creams and gels have been shown to be effective for treating chronic neuropathic pain. Neuropathic pain is pain coming from damaged nerves. It differs from pain messages carried along healthy nerves from damaged tissue that can come from a burn or a cut. Gabapentin has an average rating of 6.6 out of 10 from a total of 10 reviews for the off-label treatment of Vulvodynia. 40% of reviewers reported a positive experience, while 20% reported a negative experience. Alongside psychosocial interventions and physiotherapy, pharmacological treatment such as oral gabapentin are used in the treatment of vulvodynia. Topical formulations of gabapentin have shown promise in animal models and case reports investigating its use in other pain conditions. For treating vulvodynia, gabapentin works by inhibiting pain signals that are sent from damaged neurons. The retrospective study that was published in Obstetrics and Gynecology showed that gabapentin cream was well tolerated and effective for women experiencing vulvodynia. About 80% of the women using the cream showed at least a 50% improvement Gabapentin has been employed in vulvodynia therapy for its properties in treating neuropathic pain. Gabapentin inhibits voltage-gated calcium influx in neurons thereby preventing release of the nociceptive neurotransmitter glutamate.38 Two nonrandomized studies and 1 case report investigated the use of topical gabapentin . These include lack of control arms, small sample sizes, lack of patient randomization, and use of combination treatments. Due to the paucity of evidence, this review supports the future implementation of double-blind randomized controlled trials to further investigate the efficacy of topical gabapentin in the treatment of vulvodynia.
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