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Gabapentin for the treatment of patients with somatization disorder.

Sir: Somatization disorder is characterized by a pattern of multiple, clinically significant somatic complaints that cannot be fully explained by an known medical condition. The pharmacologic treatment of somatization disorder has scarcely been investigated owing to methodological problems, and no open or controlled trial has been conducted in patients with somatization disorder. Since pain is the most frequent symptom in somatization disorder, we selected gabapentin because it has demonstrated efficacy in patients with organic pain. We selected 29 patients (all of whom gave informed consent) from the Somatoform Disorders Unit at Hospital Universitario Miguel Servet (Zaragoza, Spain) who were diagnosed as having DSM-IV somatization disorder, with pain as the main symptom. Gabapentin was added to their previous treatment that consisted of neuroleptics, benzodiazepines, and serotonergic or tricyclic antidepressants. Gabapentin was titrated to a dosage of 1200 to 1600 mg/day, depending on the patient’s symptoms and side effects. Patients accepted to maintain unchanged their previous treatment over the 3 months of the trial to evaluate the effect of gabapentin. They were assessed at baseline and at 3 months with the Pain Visual Analogue Scale, the Clinical Global Impressions scale, the McGill Pain Questionnaire, the Global Assessment of Functioning, and the Hospital Anxiety Depression Scale. Of the intent-to-treat subjects, 6 (20.6%) dropped out of the study owing to side effects or lack of efficacy. Analyses were completed for all subjects who took at least 1 dose of gabapentin (N = 29). Patients who dropped out of the study were included in the analysis with the last observation carried forward (LOCF) to replace their missing data. Mean LOCF scores were compared with baseline scores. The statistic used was the t test for related samples. To our knowledge, this is the first open trial to assess the efficacy of any pharmacologic treatment in patients with somatization disorder. In this study, there was a statistically significant improvement (p < .01) in all measures but one, as seen in Table 1. Only the Hospital Anxiety Depression Scale showed no differences, indicating that improvement in these patients seems independent of depression and anxiety levels. In conclusion, despite the limitations of open trials, gabapentin seems to be an effective treatment for patients with somatization disorder in whom pain is the predominant symptom. This research was possible thanks to grants 98/1017 and 00/0991 from the Spanish Fondo de Investigaciones Sanitarias de la Seguridad Social (FISss).