What are the recommended first-line treatments for managing vulvodynia in primary care?

First-line treatments for managing vulvodynia in primary care focus on non-pharmacological approaches and cautious use of pharmacological options.

Initial management should include patient education, reassurance, and advice on vulvar care and avoidance of irritants.

For pharmacological treatment, consider a trial of low-dose tricyclic antidepressants such as amitriptyline, which may help with pain, sleep, and psychological distress, even if depression is not diagnosed.

Topical treatments and systemic analgesics like NSAIDs, opioids, gabapentinoids, and benzodiazepines are not recommended for chronic primary pain conditions such as vulvodynia in primary care due to lack of evidence and potential harms.

Referral to specialist pain or gynaecology services should be considered if pain is severe, significantly impacts daily life, or does not respond to initial management.

Regular review and shared decision-making are essential to tailor treatment to the patient's preferences and response.

This approach aligns with NICE guidance on managing chronic primary pain and neuropathic pain in non-specialist settings.

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