Use of oral neuromodulators in chronic pelvic painNumber 8 – 2025

Omero Benedicto Poli‐Neto, Júlio César Rosa e Silva, Carlos Alberto Petta, Carlos Augusto Pires Costa Lino, Eduardo Schor, Helizabet Salomão Abdalla Ayroza Ribeiro, João Nogueira Neto, João Sabino Cunha‐Filho, Márcia Cristina França Ferreira, Márcia Mendonça Carneiro, Marco Aurélio Pinho Oliveira, Marcos Tcherniakovsky, Maurício Simões Abrão, Raquel Papandreus Dibi, Ricardo de Almeida Quintáiros, Sérgio Podgaec, Sidney Pearce
In: Revista Brasileira de Ginecologia e Obstetrícia · 2025 · vol. 47 · doi:10.61622/rbgo/2025fps8 · PMID:41341930 · PMC12671683 · W4415814992
review OA: gold CC0 ⤵ 1 in-corpus citation
📄 Open PDF View on OpenAlex View on PubMed View at publisher
⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

Oral neuromodulators like pregabalin, nortriptyline, duloxetine, and venlafaxine are important for gynecologists treating chronic pelvic pain, with monotherapy recommended first to manage neuropathic and nociplastic pain components.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This 2025 FEBRASGO position statement reviews evidence for using oral neuromodulators—focusing on antidepressants (tricyclics and SNRIs), gabapentinoids, and cannabinoids—in women with chronic pelvic pain, emphasizing classification into nociceptive, neuropathic, and nociplastic pain and the roles of neuropathic mechanisms and central sensitization. It reports that gabapentinoids are prioritized first-line for neuropathic pain, while SNRIs are prioritized for nociplastic pain, and it highlights drug-class comparative points such as pregabalin’s pharmacokinetic profile, nortriptyline’s adverse-effect profile, duloxetine’s widespread use and low risk framing, and venlafaxine as second-line; it also notes that monotherapy is recommended initially to avoid polypharmacy, with treatment commonly maintained for at least 6 to up to 12 months. The statement explicitly limits its scope by not covering all adjuvant options and by presenting only medications with the most supporting evidence or increasing media appeal, and it also acknowledges gaps in the literature regarding ideal dosing, duration, and long-term outcomes for some drug classes. Relevance to endometriosis: the document is produced by FEBRASGO’s National Specialized Commission on Endometriosis and discusses chronic pelvic pain with nociplastic and neuropathic components where endometriosis is among the clinical conditions implicated in this pain framework, though it does not provide a condition-specific endometriosis efficacy analysis within the excerpt provided.

Read from the paper's body, not the abstract. Not a substitute for reading the paper. No clinical advice. How this works

Abstract

•Chronic pelvic pain is a common and complex condition that significantly affects women's quality of life. •Neuropathic pain and nociplastic pain are important components in the pain picture of these patients and should be considered in clinical treatment. •Oral neuromodulators, antidepressants and anticonvulsants for the control of neuropathic and nociplastic pain should be present in the therapeutic arsenal of the gynecologist who treats patients with chronic pelvic pain. •Pregabalin is the medication with the best pharmacokinetic profile; nortriptyline has the best adverse effects profile; duloxetine is the most widely used and has the lowest risks; and venlafaxine should be used as a second-line inhibitor. •Although the drug classes can be combined to reduce the total doses and minimize side effects, maximizing the analgesic effect, monotherapies are recommended as the first line to avoid polypharmacy.

My notes (saved in your browser only)

Condition tags

chronic_pelvic_pain

Citation neighborhood (sparse)

Too few in-corpus citations on either side for a chart; here are the lists.

Cites (3)

Cited by (2)

References (18)

Cited by (2)

Source provenance

europepmc
last seen: 2026-06-12T06:13:51.797165+00:00
openalex
last seen: 2026-06-10T17:14:06.276822+00:00
License: CC0 · commercial use OK