Nuffield Department of Obstetrics and Gynaecology, The Women's Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK.
Curr Opin Support Palliat Care. 2011 Jun;5(2):143-9. doi: 10.1097/SPC.0b013e3283460b05.
Pelvic pain is a common complaint of women that is frequently poorly managed. This review considers the current understanding of the mechanisms of pain perception and the development of chronic pain in the context of three gynaecological pain conditions. Recent advances in the management of these conditions are then discussed.
Persistent pelvic pain is associated with central changes, reflected by alterations in psychology, brain structure and function, and dysfunction of the hypothalamic-pituitary-adrenal axis. The many similarities among the conditions support the notion that chronic pain should be treated as a symptom in its own right, however, obtaining a diagnosis remains important to patients. Few new treatments have been developed recently, however, older treatments are being subjected to more rigorous testing and improvements in phenotyping should lead to better design of clinical trials.
Good quality, well designed clinical trials are urgently required to improve the treatment of pelvic pain in women. However, a variety of successful treatments exist and outcomes can be optimized by individualizing treatment strategies in the context of a multidisciplinary package.
盆腔疼痛是女性常见的主诉，但常常治疗效果不佳。本文在三种妇科疼痛疾病的背景下，考虑了目前对疼痛感知机制和慢性疼痛发展的理解，并讨论了这些疾病的治疗进展。
持续性盆腔疼痛与中枢变化有关，表现为心理、大脑结构和功能的改变，以及下丘脑-垂体-肾上腺轴功能障碍。这些疾病之间有许多相似之处，这支持了这样一种观点，即慢性疼痛应该被视为一种独立的症状来治疗，然而，获得诊断对患者仍然很重要。最近几乎没有开发出新的治疗方法，但旧的治疗方法正在接受更严格的测试，表型改善应该会导致临床试验的更好设计。
迫切需要高质量、精心设计的临床试验来改善女性盆腔疼痛的治疗。然而，存在多种有效的治疗方法，通过在多学科综合治疗方案的背景下对治疗策略进行个体化，可以优化治疗效果。
