Heim C, Ehlert U, Hanker J P, Hellhammer D H
Center for Psychobiological and Psychosomatic Research, University of Trier, Germany.
J Psychosom Obstet Gynaecol. 1999 Mar;20(1):11-20. doi: 10.3109/01674829909075572.
Chronic pelvic pain (CPP) is a frequent and often unexplained gynecological complaint. We attempted to evaluate stress history, psychological features and hypothalamic-pituitary-adrenal (HPA) axis function in a group of patients suffering from CPP associated with pelvic adhesions. We recruited 10 patients with CPP and adhesions and 14 painfree, infertile control patients who underwent gynecological examination and diagnostic laparoscopy in a general hospital. Psychological assessment included structured interviews on sexual and physical abuse experiences and major life events as well as questionnaires on pain characteristics and depression. To evaluate HPA axis function, we measured plasma adrenocorticotropin (ACTH) and salivary cortisol responses to the administration of 100 micrograms human corticotropin-releasing factor (CRF). Results revealed high, but not statistically increased, prevalence rates of sexual and physical abuse for patients with CPP and adhesions as compared to controls. Patients with CPP and adhesions reported a significantly higher total number of major life events. Mean depression scores were normal in both groups. Patients with CPP and adhesions demonstrated normal plasma ACTH, but decreased salivary cortisol levels in the CRF stimulation test. These preliminary findings suggest that stress and neuroendocrine changes may also contribute to the pathophysiology of CPP with an identified organic correlate.
慢性盆腔疼痛（CPP）是一种常见且往往原因不明的妇科病症。我们试图评估一组患有与盆腔粘连相关的CPP患者的应激史、心理特征和下丘脑 - 垂体 - 肾上腺（HPA）轴功能。我们招募了10例患有CPP和粘连的患者以及14例无疼痛的不孕对照患者，这些患者在一家综合医院接受了妇科检查和诊断性腹腔镜检查。心理评估包括关于性虐待和身体虐待经历以及重大生活事件的结构化访谈，以及关于疼痛特征和抑郁的问卷调查。为了评估HPA轴功能，我们测量了血浆促肾上腺皮质激素（ACTH）和唾液皮质醇对给予100微克人促肾上腺皮质激素释放因子（CRF）的反应。结果显示，与对照组相比，患有CPP和粘连的患者性虐待和身体虐待的患病率较高，但无统计学意义的增加。患有CPP和粘连的患者报告的重大生活事件总数明显更高。两组的平均抑郁评分均正常。患有CPP和粘连的患者在CRF刺激试验中血浆ACTH正常，但唾液皮质醇水平降低。这些初步发现表明，应激和神经内分泌变化也可能导致伴有明确器质性关联的CPP的病理生理过程。
