Gabapentin: Before Using for Pelvic Pain, Read This

This transcript has been edited for clarity.

Recommendations to avoid opioids in the treatment of chronic pain have focused our attention on the use of nonopioid medications, including gabapentin. Chronic pelvic pain (CPP) is an unpleasant condition that negatively impacts many aspects of patients' lives and is challenging for clinicians to treat. (See Chronic Pelvic Pain in Women: Common, Complex and Real.) The Practice Bulletin from the American College of Obstetricians and Gynecologists recommended gabapentin as a pharmacologic strategy for the treatment of CPP.

A recently published high-quality study should cause us to rethink gabapentin's role in treating CPP. In this British trial, researchers performed a double-blind study at 37 centers which randomized over 300 women age 18-50 years to gabapentin or visually matching placebo for 16 weeks.

To be eligible for this trial, no obvious gynecologic cause of pain could be noted at laparoscopy. Eligible women with CPP had to rate their pain as 4 or higher using a numerical rating scale (NRS), with zero being no pain and 10 the worst pain imaginable.

The gabapentin dose could be increased to a high of 2700 mg daily.

At study conclusion, the primary outcomes — worst and average NRS pain scores — were similar in the gabapentin and placebo groups.