Labat J-J, Riant T, Delavierre D, Sibert L, Watier A, Rigaud J
Centre fédératif de pelvipérinéologie, clinique urologique, CHU de Nantes, 44093 Nantes, France.
Prog Urol. 2010 Nov;20(12):1027-34. doi: 10.1016/j.purol.2010.08.056. Epub 2010 Oct 16.
Analysis of complex pelvic and perineal pain.
Review of the literature concerning the various types of functional pelvic pain.
Various forms of pelvic pain are frequently associated: painful bladder syndrome (interstitial cystitis), irritable bowel syndrome, endometriosis pain, vulvodynia, chronic pelvic pain syndrome (chronic prostatitis). Pelvic pain is often associated with fibromyalgia or complex regional pain syndrome (reflex sympathetic dystrophy). The pathophysiological mechanisms involved in these syndromes are all very similar, suggesting a triggering element, neurogenic inflammation, reflex muscular and autonomic responses, central hypersensitization, emotional reactions and biopsychosocial consequences.
The concept of visceral pain is evolving and, in practice, complex pelvic pain can comprise neuropathic components, complex regional pain syndrome components, hypersensitization components, and emotional components closely resembling posttraumatic stress syndrome.
When pain cannot be explained by an organ disease, the pain must be considered to be expressed via this organ. Chronic pelvic and perineal pain can become self-perpetuating and identification of its various mechanisms can allow the proposal of individually tailored treatments.
分析复杂的盆腔和会阴疼痛。
回顾有关各种类型功能性盆腔疼痛的文献。
多种形式的盆腔疼痛常相互关联：膀胱疼痛综合征（间质性膀胱炎）、肠易激综合征、子宫内膜异位症疼痛、外阴痛、慢性盆腔疼痛综合征（慢性前列腺炎）。盆腔疼痛常与纤维肌痛或复杂区域疼痛综合征（反射性交感神经营养不良）相关。这些综合征所涉及的病理生理机制都非常相似，提示存在触发因素、神经源性炎症、反射性肌肉和自主神经反应、中枢敏化、情绪反应以及生物心理社会后果。
内脏痛的概念正在演变，在实际中，复杂的盆腔疼痛可能包括神经病理性成分、复杂区域疼痛综合征成分、敏化成分以及与创伤后应激综合征极为相似的情绪成分。
当疼痛无法用器官疾病解释时，必须认为疼痛是通过该器官表现出来的。慢性盆腔和会阴疼痛可能会持续存在，识别其各种机制有助于提出个体化的治疗方案。
