Is gabapentin effective for women with unexplained chronic pelvic pain?

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

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.