Kirste Unni, Haugstad Gro Killi, Leganger Siv, Blomhoff Svein, Malt Ulrik Fredrik
Kvinneklinikken, Rikshospitalet Sognsvannsveien 20 0027 Oslo.
Tidsskr Nor Laegeforen. 2002 May 10;122(12):1223-7.
This paper reviews empirical and clinical evidence of the aetiology and treatment of medically unexplained chronic pelvic pain in women.
Clinical experience from an ongoing randomised treatment trial supplemented by computer-assisted reviews of studies obtained by a Premedline and Medline search (1996 to February 2002) and data from the Cochrane Database of Systematic Reviews and the EBM database of Abstracts of Reviews of Effectiveness.
The aetiology of medically unexplained chronic pelvic pain is disputed but likely to be multifactorial. A history of interpersonal difficulties and a stressful life is common, and comorbid psychiatric disorders occur frequently. No treatment of choice emerges from the few controlled treatment trials, though a flexible biopsychosocial approach seems the most promising.
Empathic medical evaluation and follow-up within a biopsychosocial framework is recommended. Analgesic, hormonal and, if appropriate, surgical treatment can relieve pain. Additional benefits may be obtained by adding sensory awareness-directed physiotherapy aimed at changing painful muscle tensions, body attitude, movement pattern and dysfunctional respiration pattern. Co-morbid psychiatric disorders should be diagnosed and treated. Cognitive-behavioural stress management intervention aimed at improving coping with pain and current life-situation may be indicated in a subsample of patients.
本文综述了女性医学上无法解释的慢性盆腔疼痛的病因及治疗的实证和临床证据。
来自一项正在进行的随机治疗试验的临床经验，并辅以通过Premedline和Medline检索（1996年至2002年2月）获得的研究的计算机辅助综述，以及来自Cochrane系统评价数据库和有效性综述摘要的循证医学数据库的数据。
医学上无法解释的慢性盆腔疼痛的病因存在争议，但可能是多因素的。人际关系困难和生活压力大的病史很常见，共病精神障碍也经常发生。在少数对照治疗试验中没有出现首选治疗方法，不过灵活的生物心理社会方法似乎最有前景。
建议在生物心理社会框架内进行共情医学评估和随访。镇痛、激素治疗以及在适当情况下的手术治疗可以缓解疼痛。通过增加旨在改变疼痛肌肉紧张、身体姿势、运动模式和功能失调呼吸模式的感觉意识导向的物理治疗，可能会获得额外益处。应诊断并治疗共病精神障碍。针对改善应对疼痛和当前生活状况的认知行为压力管理干预可能适用于部分患者。
