A systematic review of drug treatment of vulvodynia: evidence of a strong placebo effect

BackgroundVulvodynia is the most common type of chronic pelvic pain and dyspareunia in premenopausal women. The effect of drugs for the treatment of vulvodynia remains poorly discussed. ObjectivesTo conduct a systematic review of randomised controlled studies which assess medications used to treat vulvar pain in vulvodynia. Search strategyWeb of Science, Cochrane Library, EBSCO Academic, LILACS and MEDLINE were searched from 1985 to September 2016. Selection criteriaRandomised controlled trials comparing any kind of medication for vulvodynia treatment with placebo or with another medication in adult patients were included. Data collection and analysisThe two investigators independently conducted data extraction. The synthesis was provided by the pain reduction index. Study quality assessment was performed using the Cochrane Handbook for Systematic Reviews of Intervention and analysis of publication bias was conducted. Main resultsFive studies were included in qualitative synthesis. Number of participants varied from 30 to 133 participants among the eligible studies, resulting in a total of 297 patients. The pain reduction rates of patients with vulvodynia assessed by Q-tipped cotton test and visual analogue scale varied between studies. Placebo was shown to be as effective as any medication. ConclusionsThere is a need for further studies evaluating topical monotherapy for the treatment of vulvodynia, as they are the main drugs used in clinical practice. Tweetable abstractNo medication has shown impact on vulvar pain in vulvodynia. There is evidence of a placebo effect. Tweetable abstract No medication has shown impact on vulvar pain in vulvodynia. There is evidence of a placebo effect.