Open-label trial of lamotrigine focusing on efficacy in Vulvodynia

Department of Psychiatry, University of North Carolina at Chapel Hill, Campus Box 7160, Chapel Hill, NC 27599, USA.
The Journal of reproductive medicine (Impact Factor: 0.7). 04/2009; 54(3):171-8.
Source: PubMed


Chronic pelvic pain (CPP) affects 15% of women and has a high rate of psychiatric comorbidity. Vulvodynia, a vulvar pain syndrome that includes vulvar vestibulitis, is the most common subtype of CPP. This study examined the efficacy of lamotrigine for the treatment of CPP using an open-label design.
Forty-three women with CPP were recruited from a specialty pelvic pain clinic. Of these, 31 completed 8 weeks of active treatment. Outcome variables included the McGill Pain Rating Index and subscales of pain intensity and the Hamilton Depression and Anxiety Rating Scales.
We found significant reductions in all pain and mood measures at the 8-week visit compared to baseline. In particular, women with vulvodynia-type CPP (N = 17) had robust reductions in pain and mood symptoms.
CPP is a heterogeneous disorder, with psychiatric comorbidity and poor treatment response. This open-label study suggests that treatment with lamotrigine in women with the vulvodynia subtype of CPP may be helpful in addressing both the pain and mood symptoms associated with this disorder.

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    ABSTRACT: Chronic pain syndromes are often treatment refractory and pose an enormous burden of suffering for the individual. Chronic pelvic pain (CPP) is generally defined as noncyclic pain of at least 6 months duration and severe enough to require medical care or cause disability. CPP has been estimated to have a prevalence of 15% among women of reproductive age. Women are at increased risk for both major depression and chronic pain syndromes such as CPP, and are more likely to report antecedent stressful events, have higher rates of physical and sexual abuse, and subsequently develop posttraumatic stress disorder. High rates of sexual and physical abuse and other trauma have been shown among women with CPP, including symptoms of dyspareunia (pain during intercourse), dysmenorrhea (pain during menstruation), and vulvar pain. A detailed and comprehensive evaluation of the patient with CPP should include a thorough gynecologic exam and a full mental health assessment. Treatment of CPP must include an integrated approach targeted at both the psychiatric comorbidity and pain symptoms. A multidisciplinary treatment team offers the best chance for success with CPP, and it is critical to suggest psychiatric treatment (psychopharmacology and/or psychotherapy) in addition to traditional medical and surgical approaches.
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    ABSTRACT: INTRODUCTION: Anticonvulsants have increasingly been invoked in the treatment of vulvodynia. However, the evidence supporting this treatment approach has not been systematically assessed. AIM: The study aims to evaluate the efficacy of anticonvulsant pharmacotherapy in the treatment of vulvodynia. METHODS: A comprehensive search of the available literature was conducted. MAIN OUTCOME MEASURE: An assessment of the methodological quality of published reports addressing the utility of anticonvulsants in the treatment of vulvodynia was undertaken. RESULTS: The search yielded nine published reports, i.e., one open-label trial, six nonexperimental studies, and two case reports. A number of methodological shortcomings were identified in several of the reports with respect to study design, including small sample sizes, lack of placebo or other comparison groups, inadequate outcome measures, among others. The vast majority of studies employed gabapentin. Evidence supporting the benefit of anticonvulsants studied to date was limited, i.e., based predominantly upon descriptive/observational reports. There were no systematic investigations into the comparative efficacy of different anticonvulsant agents in the treatment of vulvodynia. CONCLUSION: Although some vulvodynia-afflicted patients derive symptom relief from anticonvulsants, there is, as yet, insufficient evidence to support the recommendation of anticonvulsant pharmacotherapy in the treatment of vulvodynia. Additional investigations, employing randomized controlled trials, are warranted. Leo RJ. A systematic review of the utility of anticonvulsant pharmacotherapy in the treatment of vulvodynia pain. J Sex Med **;**:**-**.
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