The Effect of Neuromodulatory Drugs on the Intensity of Chronic Pelvic Pain in Women: A Systematic Review

Abstract

Objective: To evaluate the effect of neuromodulatory drugs on the intensity of chronic pelvic pain (CPP) in women. Data sources: Searches were carried out in the PubMed, Cochrane Central, Embase, Lilacs, OpenGrey, and Clinical Trials databases. Selection of studies: The searches were carried out by two of the authors, not delimiting publication date or original language. The following descriptors were used: chronic pelvic pain in women OR endometriosis, associated with MESH/ENTREE/DeCS: gabapentinoids, gabapentin, amitriptyline, antidepressant, pregabalin, anticonvulsant, sertraline, duloxetine, nortriptyline, citalopram, imipramine, venlafaxine, neuromodulation drugs, acyclic pelvic pain, serotonin, noradrenaline reuptake inhibitors, and tricyclic antidepressants, with the Boolean operator OR. Case reports and systematic reviews were excluded. Data collection: The following data were extracted: author, year of publication, setting, type of study, sample size, intervention details, follow-up time, and results. Data synthesis: A total of 218 articles were found, with 79 being excluded because they were repeated, leaving 139 articles for analysis: 90 were excluded in the analysis of the titles, 37 after reading the abstract, and 4 after reading the articles in full, and 1 could not be found, therefore, leaving 7 articles that were included in the review. Conclusion: Most of the studies analyzed have shown pain improvement with the help of neuromodulators for chronic pain. However, no improvement was found in the study with the highest statistical power. There is still not enough evidence that neuromodulatory drugs reduce the intensity of pain in women with CPP.

Manejo laparoscópico y farmacológico del dolor de miembro pélvico en pacientes con endometriosis profunda: resultados de una serie de casos

“…Se ha demostrado incluso que el uso de gabapentina y pregabalina tienen un efecto sinérgico para el manejo del dolor en endometriosis a pesar de sus similitudes farmacológicas. 13 En pequeños estudios aleatorizados no se ha demostrado que la sertralina tenga efecto analgésico sobre el placebo para el tratamiento del dolor pélvico crónico 14 la mayoría de las pacientes presentan dolores mixtos y requieren de terapias combinadas. 15 La mayoría de las pacientes presentan retraso de años para recibir un tratamiento adecuado para la endometriosis profunda, mermando significativamente su calidad de vida.…”

“…8,9 El abordaje ideal de la endometriosis profunda debe realizarse por laparoscopía o cirugía robótica para tener buena visualización de las lesiones y poder llevar a cabo una resección efectiva de los nódulos e implantes peritoneales, 4 así como preservar la mayor parte de tejido ovárico funcional tomando en cuenta que esta patología es característica de mujeres en edad reproductiva. En estudios donde sólo se ha indicado terapia médica no se ha documentado ninguna mejoría de las pacientes; 13,16 es importante hacerles hincapié, desde el inicio del tratamiento, que esta es una enfermedad crónica, que aunque se busque la mejoría y la recuperación de su calidad de vida es muy probable que el dolor nunca desaparezca por completo, a pesar del tratamiento adecuado. Es de vital importancia la terapia combinada médica y quirúrgica, así como los cambios en la dieta y el estilo de vida, se deben mantener estos de manera constante para una mejoría significativa del dolor.…”

Evaluation and Medical Management of Chronic Pelvic Pain

“…There is scarce evidence on the pain benefits of these drugs in patients with visceral pain syndromes or patients with CPP. 30 The analgesic effect is thought to be from the inhibition of the reuptake of serotonin and noradrenaline, increasing neurotransmitter availability, and subsequently increasing inhibitory pain control. CPP, while not considered exclusively a neuropathic pain disorder, may benefit from the neuromodulatory effect of these medications in addition to its effect on comorbid psychiatric diseases when present.…”

“…A recent systematic review evaluated the effect of neuromodulatory drugs on CPP pain intensity, and while most studies reported some improvement in pain, the highest quality study showed no differences compared to placebo. 30 This study, known as the GaPP2 trial (Gabapentin for Chronic Pelvic Pain in Women), is a multicenter, randomized, double-blind, placebo-controlled trial comparing high systemic doses of gabapentin in women with CPP, specifically excluding women with known causes of pain, such as endometriosis. Despite this, gabapentinoids are frequently used clinically, have a good safety profile, and few drug interactions.…”

Cannabis and Endometriosis: The Roles of the Gut Microbiota and the Endocannabinoid System

“…These modify the endocrine environment in both eutopic endometrium and ectopic lesions and hinder the inflammatory pathway involved in pelvic pain [21]. Commonly used anti-neuropathics include amitriptyline, pregabalin and gabapentin [22], the use of which is common among those experiencing chronic pelvic pain. Previous clinical trials [22] have shown the effectiveness of gabapentin on CPP, but currently, its effectiveness in endometriosis may not be effective due to the fact that endometriosis-associated pain tends not to be neuropathic [21].…”