Practice Uncertainties

Is gabapentin effective for women with unexplained chronic pelvic pain?

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3520 (Published 21 September 2017) Cite this as: BMJ 2017;358:j3520
  1. Andrew W Horne, professor of gynaecology and reproductive sciences and honorary consultant gynaecologist1,
  2. Katy Vincent, senior pain fellow and consultant gynaecologist2,
  3. Roman Cregg, consultant in pain medicine and anaesthesia and honorary senior clinical lecturer3,
  4. Jane Daniels, professor of clinical trials4
  1. 1MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
  2. 2Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK
  3. 3Pain Management Centre, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
  4. 4Nottingham Clinical Trial Unit, University of Nottingham, Nottingham, UK
  1. Correspondence to AW Horne andrew.horne{at}ed.ac.uk

This article is linked with a commentary on “What to do in the light of this uncertainty” by James Duffy.

What you need to know

  • Up to half of all women with chronic pelvic pain in secondary care have no obvious underlying pathology

  • For pain relief, a combination of drugs, physiotherapy, and cognitive behavioural therapy can be tried

  • There is no strong direct evidence to support the use of gabapentin for women with chronic pelvic pain, and uncertainty remains regarding its safety, and clinical and cost effectiveness

Chronic pelvic pain in women is a common presentation in primary care. Pain persists or recurs over at least six months1 and can be distressing, affecting physical function, quality of life, and productivity.2 Nearly 38 per 1000 women are affected annually in the UK. Global estimates range from 2.1% to 24% of the female population.34

Endometriosis, adenomyosis, adhesions, pelvic inflammatory disease, irritable bowel syndrome, bladder pain syndrome, nerve entrapment, and musculoskeletal pain are among the common causes.45 These are often identified by screening for pelvic infection (eg, Chlamydia trachomatis), pelvic imaging (eg, ultrasound, magnetic resonance imaging), and diagnostic laparoscopy.1 Some 40%-55% of women with chronic pelvic pain in secondary care appear to have no obvious underlying pathology based on clinical history, examination, and investigations.46 Management of this group of women is challenging and there are few established gynaecological treatments. The Royal College of Obstetricians and Gynaecologists recommends a combination of pharmacological interventions, physiotherapy, and cognitive behavioural therapy.1 Often women try several methods sequentially or in combination.478Figure 1 presents a common diagnostic and treatment approach that women with chronic pelvic pain might be offered.

Fig 1 Flow diagram showing the possible “treatment journey” (and timelines) for a woman who presents to primary care with …

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