MedicalResearch.com Interview with:
Gloria A Bachmann, MD
Professor of Obstetrics and Gynecology and Medicine
Associate Dean for Women’s Health
Director, Women’s Health Institute
Rutgers Robert Wood Johnson Medical School
MedicalResearch.com: What is the background for this study?
Response: Chronic pain is an extremely difficult symptom for anyone to deal with, regardless of the cause. However, when the pain involves the genital area, it exacerbates the pain condition, as it then becomes a more sensitive area for the person to talk about and to feel comfortable in asking for medical help. This is precisely the case for women with vulvodynia.
Vulvodynia is defined as a pain that persists over several months in the outer area of the vaginal opening. Symptoms women often have from this condition, in addition to the pain itself, include burning, pressure, itching and soreness. Some women note the pain in the entire area surrounding the vaginal opening, whereas others only note it in one or two sites. Further, for many women the pain interferes with their ability to engage in sexual exchange, the wearing of certain types of clothing and even the ability to start a family as coital activity may not be possible for them. Unfortunately, because the exact cause of vulvodynia has not been described, treatments are varied and aim at treating the pain rather than the underlying cause. One intervention that has been used for women with this condition is the medication, gabapentin. However, although it appears to be a successful intervention for some sufferers, there had not been a definitive clinical trial that looked at this medication as it compares to a placebo intervention.
Therefore, our Rutgers site, along with the University of Tennessee and the University of Rochester commenced a clinical trial to test how effective gabapentin was as compared to a placebo, or non-pharmacologic intervention in women with this condition.
MedicalResearch.com: What are the main findings?
Response: After the study was completed, we found that there are certain women who benefit from gabapentin intervention. That not all women had the same positive response. For example, in our sample, the women who were having sexual pain from increased muscle tone in the lower vaginal area, had a better response than women who did not have increased muscle tone in this area. These results confirm that for most medical conditions there may not be a one size fits all approach and that it is important for all individuals, especially those with chronic pain, to work with their clinicians in defining a management strategy that is best for them.
Response: One of the take home messages from this study is that every person is unique and despite the fact that all of the women in this study had vulvodynia, other factors and symptoms were present in some individuals and not others. Therefore, all women with vulvodynia should keep an open dialogue with their health care provider so that management interventions can be determined on their individual history, physical exam and response to an intervention. The other important take home message is for women not to get discouraged if initial management strategies do not provide adequate pain relief. Many times what works for one woman in relieving symptoms may not work for another.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: The most important recommendation from my perspective is not so much the specific question that should be evaluated in the next clinical trial, but to encourage all women with vulvodynia to participate in clinical trials that study this chronic pain condition. That is, the only way clinical discoveries for best treatment of all medical conditions, including pain conditions, can happen is for individuals with that condition be open to participating in a clinical trial. The women who participated in this clinical trial should be applauded as with their study participation, they gave us much needed information for all women about individualizing treatment.
MedicalResearch.com: Is there anything else you would like to add?
Response: Both Dr. Phillips, who was my research partner in this study, and I are clinicians and advocates for women. Dr. Phillips is Director of the Vulvovaginal Health Program and I am the Director of the Women’s Health Institute at Rutgers Robert Wood Johnson Medical School. We want to emphasize to all women that they should never hold back in discussing any issues or complaints with their health care provider. All women should be open with their clinician regarding their medical concerns, learn about all options when confronted with a medical issue and never consider a medical question that they have not an important one.>
Am J Obstet Gynecol. 2019 Jan;220(1):89.e1-89.e8. doi: 10.1016/j.ajog.2018.10.021. Epub 2018 Oct 24.
Effect of gabapentin on sexual function in vulvodynia: a randomized, placebo-controlled trial.
Bachmann GA1, Brown CS2, Phillips NA3, Rawlinson LA2, Yu X4, Wood R5, Foster DC5; Gabapentin Study Group.
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