Department of Surgical Sciences, Institute of Obstetrics and Gynaecology, University of Foggia. Via Pinto, 71100 Foggia, Italy.
Eur J Obstet Gynecol Reprod Biol. 2010 May;150(1):76-9. doi: 10.1016/j.ejogrb.2010.01.008. Epub 2010 Feb 21.
Endometriosis is a chronic oestrogen-dependent gynaecological disorder, the most common symptom of which is pain. Inflammation can be considered one of the major causes of pain in endometriosis. In particular, degranulating mast cells have been found in significantly greater quantities in endometriotic lesions than in unaffected tissues. The increase in activated and degranulating mast cells is closely associated with nerve structures in painful endometriotic lesions. These observations indicate that inflammation due to mast cells may contribute to the development of pain and hyperalgesia in endometriosis. Controlling mast-cell activation may therefore relieve the pain associated with endometriotic lesions.
Four patients presenting an endometriosis-related pain intensity >or=5 (visual analogue scale for pain, or VAS) were enrolled and monitored during 3 months of the following treatment: oral palmitoylethanolamide 400mg and polydatin 40mg, twice daily for 90 days. Deep dyspareunia, dyschezia, dysuria, dysmenorrhoea and analgesic drug use during the 3-month follow-up period were also monitored, with the aim of demonstrating a reliable reduction in chronic pelvic pain.
The preliminary results indicate that all patients enrolled experienced pain relief as early as 1 month after starting treatment. Furthermore, a reduction in the analgesic drugs usually employed for pain control was observed in all subjects treated. Additionally, some improvements in endometriotic lesions seemed to be demonstrated by imaging.
The palmitoylethanolamide-polydatin combination seems to be very useful in controlling chronic pelvic pain associated with endometriosis. As a result of these findings we have initiated a multi-centre pilot study to verify the effectiveness of this treatment in controlling the chronic pelvic pain associated with endometriosis.
子宫内膜异位症是一种慢性雌激素依赖性妇科疾病，其最常见的症状是疼痛。炎症可以被认为是子宫内膜异位症疼痛的主要原因之一。特别是，在子宫内膜异位症病变中发现脱颗粒肥大细胞的数量明显多于未受影响的组织。激活和脱颗粒肥大细胞的增加与疼痛性子宫内膜异位症病变中的神经结构密切相关。这些观察结果表明，肥大细胞引起的炎症可能导致子宫内膜异位症疼痛和痛觉过敏的发展。因此，控制肥大细胞的激活可能会缓解与子宫内膜异位症病变相关的疼痛。
纳入了 4 名疼痛强度≥5 的子宫内膜异位症相关疼痛患者（疼痛视觉模拟量表或 VAS），并在 3 个月的以下治疗期间进行监测：口服棕榈酸乙醇酰胺 400mg 和虎杖苷 40mg，每日两次，共 90 天。在 3 个月的随访期间，还监测了深部性交痛、排便困难、排尿困难、痛经和镇痛药的使用，目的是证明慢性盆腔疼痛的可靠缓解。
初步结果表明，所有入组患者在开始治疗后 1 个月内即开始缓解疼痛。此外，所有接受治疗的患者都观察到用于疼痛控制的镇痛药用量减少。此外，一些影像学检查似乎显示子宫内膜异位症病变有所改善。
棕榈酸乙醇酰胺-虎杖苷联合用药似乎非常有助于控制与子宫内膜异位症相关的慢性盆腔疼痛。由于这些发现，我们已经启动了一项多中心试点研究，以验证这种治疗方法在控制与子宫内膜异位症相关的慢性盆腔疼痛方面的有效性。
