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外阴痛:文献综述

Vulvodynia: A Review of the Literature.

作者信息

Loflin Bobbi Jo, Westmoreland Kearsten, Williams Nancy Toedter

机构信息

Southwestern Oklahoma State University, Weatherford, OK, USA.

出版信息

J Pharm Technol. 2019 Feb;35(1):11-24. doi: 10.1177/8755122518793256. Epub 2018 Aug 20.

Abstract

To evaluate the literature and educate the pharmacy community about the different treatment options for vulvodynia. Searches were performed through MEDLINE (1946-May 2018) using OVID and EBSCOhost, and Excerpta Medica (1974-May 2018) using EMBASE. Search terms included , , , , , and . References of all relevant articles were then used to find additional applicable articles. This review includes articles in the English language and human trial literature. Twenty-five trials explored the use of oral and topical medications in the treatment of vulvodynia. Vulvodynia is a poorly understood disease with an unknown etiology. Oral tricyclic antidepressants and gabapentin continue to be the most commonly used treatments for vulvodynia pain. This is due to their ease of use and patient preference. Topical treatments that have efficacy data are amitriptyline, gabapentin, lidocaine, baclofen, and hormones. This route of administration avoids systemic adverse effects and interpatient variability that accompanies oral administration. Alternative therapies more commonly used include physiotherapy, psychotherapy, and surgery. Treatment length may vary due to dose titrations and potential changes in medication therapy. Several medication and alternative therapies may be effective in treating vulvodynia. Current studies used wide dosing ranges, making it difficult to standardize therapy. No consistent method of assessing pain was used between studies, as well as a limited number being randomized and placebo controlled. Additional research is needed to increase knowledge and further develop vulvodynia treatments.

摘要

评估相关文献,并就外阴痛的不同治疗选择对药学界进行教育。通过使用OVID和EBSCOhost检索MEDLINE(1946年 - 2018年5月),以及使用EMBASE检索医学文摘(1974年 - 2018年5月)。检索词包括[具体检索词未给出]。然后利用所有相关文章的参考文献来查找其他适用文章。本综述纳入英文文章和人体试验文献。25项试验探讨了口服和局部用药治疗外阴痛的情况。外阴痛是一种病因不明、了解甚少的疾病。口服三环类抗抑郁药和加巴喷丁仍然是治疗外阴痛最常用的药物。这是由于其使用方便且患者更倾向使用。有疗效数据的局部治疗药物有阿米替林、加巴喷丁、利多卡因、巴氯芬和激素。这种给药途径可避免口服给药伴随的全身不良反应和患者间的变异性。更常用的替代疗法包括物理治疗、心理治疗和手术。治疗时长可能因剂量滴定和药物治疗的潜在变化而有所不同。几种药物和替代疗法可能对外阴痛有效。目前的研究使用的给药范围很广[此处原文表述似乎有误,推测可能是“剂量范围很广”],使得治疗难以标准化。研究之间没有使用一致的疼痛评估方法,并且随机化和安慰剂对照的研究数量有限。需要进一步研究以增加相关知识并进一步开发外阴痛的治疗方法。

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