Systematic review and meta-analysis of the effects of treatment modalities for vestibulodynia in women

Pérez‐López, Faustino R.; Hernandez, Adrián V.; Vieira‐Baptista, Pedro; Preti, Mario; Bornstein, Jacob

doi:10.1080/13625187.2019.1643835

Cited by 5 publications

(9 citation statements)

References 31 publications

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“…The 26 reviews provided efficacy estimates for eight classes of antidepressants. Efficacy estimates for tricyclic antidepressants (TCAs) were provided in 12 reviews, 17 32 36 49 51 54 55 56 57 58 60 64 followed by selective serotonin reuptake inhibitors (SSRIs) in 11 reviews, 16 31 32 36 47 50 56 59 61 62 63 serotonin-norepinephrine reuptake inhibitors (SNRIs) in eight reviews, 16 31 32 35 45 50 52 54 tetracyclic/atypical antidepressants in four reviews, 32 36 46 51 serotonin antagonist and reuptake inhibitors (SARIs) in two reviews, 32 53 and noradrenaline-dopamine reuptake inhibitors (NDRIs) 32 and monoamine oxidase inhibitors (MAOIs) 48 in one trial each.…”

Section: Resultsmentioning

confidence: 99%

“…Eighteen reviews provided inconclusive evidence about the efficacy of antidepressants for 17 conditions in 26 distinct comparisons. 16 32 36 46 48 49 50 53 54 55 56 57 58 59 60 61 63 64 Most reviews presenting inconclusive evidence were of TCAs, with eight reviews covering nine conditions (nine comparisons). 32 49 54 55 57 58 60 64 For 17 comparisons, only one trial formed the body of evidence for the comparisons.…”

Section: Resultsmentioning

confidence: 99%

“… 16 32 36 46 48 49 50 53 54 55 56 57 58 59 60 61 63 64 Most reviews presenting inconclusive evidence were of TCAs, with eight reviews covering nine conditions (nine comparisons). 32 49 54 55 57 58 60 64 For 17 comparisons, only one trial formed the body of evidence for the comparisons. For comparisons with more than one trial available, evidence for SNRIs was inconclusive for sciatica.…”

Section: Resultsmentioning

confidence: 99%

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Efficacy, safety, and tolerability of antidepressants for pain in adults: overview of systematic reviews

Ferreira

Shaheed

Underwood

et al. 2023

BMJ

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Objective To provide a comprehensive overview of the efficacy, safety, and tolerability of antidepressants for pain according to condition. Design Overview of systematic reviews. Data sources PubMed, Embase, PsycINFO, and the Cochrane Central Register of Controlled Trials from inception to 20 June 2022. Eligibility criteria for selecting studies Systematic reviews comparing any antidepressant with placebo for any pain condition in adults. Data extraction and synthesis Two reviewers independently extracted data. The main outcome measure was pain; for headache disorders it was frequency of headaches. Continuous pain outcomes were converted into a scale of 0 (no pain) to 100 (worst pain) and were presented as mean differences (95% confidence intervals). Dichotomous outcomes were presented as risk ratios (95% confidence intervals). Data were extracted from the time point closest to the end of treatment. When end of treatment was too variable across trials in a review, data were extracted from the outcome or time point with the largest number of trials and participants. Secondary outcomes were safety and tolerability (withdrawals because of adverse events). Findings were classified from each comparison as efficacious, not efficacious, or inconclusive. Certainty of evidence was assessed with the grading of recommendations assessment, development, and evaluation framework. Results 26 reviews (156 unique trials and >25 000 participants) were included. These reviews reported on the efficacy of eight antidepressant classes covering 22 pain conditions (42 distinct comparisons). No review provided high certainty evidence on the efficacy of antidepressants for pain for any condition. 11 comparisons (nine conditions) were found where antidepressants were efficacious, four with moderate certainty evidence: serotonin-norepinephrine reuptake inhibitors (SNRIs) for back pain (mean difference −5.3, 95% confidence interval −7.3 to −3.3), postoperative pain (−7.3, −12.9 to −1.7), neuropathic pain (−6.8, −8.7 to −4.8), and fibromyalgia (risk ratio 1.4, 95% confidence interval 1.3 to 1.6). For the other 31 comparisons, antidepressants were either not efficacious (five comparisons) or the evidence was inconclusive (26 comparisons). Conclusions Evidence of efficacy of antidepressants was found in 11 of the 42 comparisons included in this overview of systematic reviews—seven of the 11 comparisons investigated the efficacy of SNRIs. For the other 31 comparisons, antidepressants were either inefficacious or evidence on efficacy was inconclusive. The findings suggest that a more nuanced approach is needed when prescribing antidepressants for pain conditions. Systematic review registration PROSPERO CRD42022311073.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Efficacy, safety, and tolerability of antidepressants for pain in adults: overview of systematic reviews

Ferreira

Shaheed

Underwood

et al. 2023

BMJ

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“…Tricyclic antidepressants (TCAs) are the most commonly prescribed centrally-targeted treatment for the management of vulvar pain [ 10 ] and have been shown to improve sexual function [ 19 ]. An open trial of nortriptyline for 2 months found that 6/7 women had a complete or partial reduction in chronic pelvic pain [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, as concluded in recent evidence-based literature reviews, interpretation of treatment success remains difficult due to the limitations of published studies, including poor patient selection, lack of adequate controls, and limited follow-up data [ 19 , 28 ]. Thus, there is a critical need for randomized controlled trials (RCTs) to evaluate the efficacy of these peripheral and centrally-targeted treatments, especially among women with different VBD subtypes.…”

Section: Introductionmentioning

confidence: 99%

Rationale and design of a multicenter randomized clinical trial of vestibulodynia: understanding pathophysiology and determining appropriate treatments (vestibulodynia: UPDATe)

et al. 2022

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Background Limited data are available to establish evidence-based management protocols for vestibulodynia (VBD), a chronic vulvar pain condition that affects approximately 14 million women in the U.S. For the purposes of the study, our group subdivided VBD subtypes that may benefit from different types of treatment: 1) VBD peripheral (VBD-p), characterized by pain localized to the vulvar vestibule and 2) VBD central (VBD-c), characterized by VBD alongside one or more other chronic overlapping pain conditions (e.g. irritable bowel syndrome, temporomandibular disorder, and fibromyalgia syndrome) that affect remote body regions. Here, we describe the rationale and design of an NIH-funded multicenter clinical trial comparing the effectiveness of topical and/or systemic medication for alleviating pain and normalizing pain- relevant biomarkers among women with VBD-p and VBD-c. Methods Participants will be randomly assigned to one of four parallel arms: peripheral treatment with 5% lidocaine + 0.5 mg/ml 0.02% oestradiol compound cream + oral placebo pill, 2) central treatment with the tricyclic antidepressant nortriptyline + placebo cream, 3) combined peripheral cream and central pill treatments, or 4) placebo cream and placebo pill. The treatment phase will last 16 weeks, with outcome measures and biomarkers assessed at 4 time points (0, 8, 16, and 24 weeks). First, we will compare the efficacy of treatments in alleviating pain using standardized tampon insertion with a numeric rating scale and self-reported pain on the short form McGill Pain Questionnaire. Next, we will compare the efficacy of treatments in improving perceived physical, mental, and sexual health using standardized questionnaires. Finally, we will measure cytokines and microRNAs in local vaginal and circulating blood samples using multiplex assays and RNA sequencing, and determine the ability of these biomarkers to predict treatment response. Conclusion This is the first multicenter randomized controlled trial to evaluate the efficacy of peripherally and centrally acting medications currently used in clinical practice for treating unique VBD subtypes based on distinct clinical and biological signatures. Administrative information Vestibulodynia UPDATe is a multi-centre, two-by-two factorial designed randomized, double-blind, placebo-controlled trial registered at clinical trials.gov (NCT03844412). This work is supported by the R01 HD096331 awarded to Drs. Nackley, Rapkin, Geller and Carey by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). Key messages Peripheral lidocaine and oestradiol and centrally-targeted nortriptyline medications are used for the treatment of pain in women with VBD, but there is a lack of data from well-powered RCTs. This two-by-two factorial RCT will test the efficacy of these medications in VBD subtypes cha...

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“Time is on my side”. Disease trajectory of vulvodynia: a systematic review with a narrative synthesis

Cetera

Merli

Facchin

et al. 2023

Arch Gynecol Obstet

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Systematic review and meta-analysis of the effects of treatment modalities for vestibulodynia in women

Cited by 5 publications

References 31 publications

Efficacy, safety, and tolerability of antidepressants for pain in adults: overview of systematic reviews

Efficacy, safety, and tolerability of antidepressants for pain in adults: overview of systematic reviews

Rationale and design of a multicenter randomized clinical trial of vestibulodynia: understanding pathophysiology and determining appropriate treatments (vestibulodynia: UPDATe)

“Time is on my side”. Disease trajectory of vulvodynia: a systematic review with a narrative synthesis

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