Kantonsspital St Gallen, Department of Urology, St Gallen, Switzerland.
Eur Urol. 2013 Sep;64(3):431-9. doi: 10.1016/j.eururo.2013.04.035. Epub 2013 Apr 28.
Progress in the science of pain has led pain specialists to move away from an organ-centred understanding of pain located in the pelvis to an understanding based on the mechanism of pain and integrating, as far as possible, psychological, social, and sexual dimensions of the problem. This change is reflected in all areas, from taxonomy through treatment. However, deciding what is adequate investigation to rule out treatable disease before moving to this way of engaging with the patient experiencing pain is a complex process, informed by pain expertise as much as by organ-based medical knowledge.
To summarise the evolving changes in the management of patients with chronic pelvic pain by referring to the 2012 version of the European Association of Urology (EAU) guidelines on chronic pelvic pain.
The working panel highlights some of the most important aspects of the management of patients with chronic pelvic pain emerging in recent years in the context of the EAU guidelines on chronic pelvic pain. The guidelines were completely updated in 2012 based on a systematic review of the literature from online databases from 1995 to 2011. According to this review, levels of evidence and grades of recommendation were added to the text. A full version of the guidelines is available at the EAU office or Web site (www.uroweb.org).
The previously mentioned issues are explored in this paper, which refers throughout to dilemmas for the physician and treatment team as well as to the need to inform and engage the patient in a collaborative empirical approach to pain relief and rehabilitation. These issues are exemplified in two case histories.
Chronic pelvic pain persisting after appropriate treatment requires a different approach focussing on pain. This approach integrates the medical, psychosocial, and sexual elements of care to engage the patient in a collaborative journey towards self-management.
疼痛科学的进步促使疼痛专家不再从位于骨盆的器官中心的角度理解疼痛，而是基于疼痛机制来理解，并尽可能整合问题的心理、社会和性方面。这种变化反映在从分类学到治疗的所有领域。然而，在转向这种与经历疼痛的患者接触的方式之前，确定排除可治疗疾病所需的充分调查是一个复杂的过程，这既需要疼痛专业知识，也需要基于器官的医学知识。
通过参考 2012 年版欧洲泌尿外科学会 (EAU) 慢性盆腔疼痛指南，总结慢性盆腔疼痛患者管理的不断变化。
工作组强调了近年来在 EAU 慢性盆腔疼痛指南背景下，慢性盆腔疼痛患者管理中出现的一些最重要的方面。该指南于 2012 年根据对 1995 年至 2011 年在线数据库文献的系统回顾进行了全面更新。根据这项审查，在文本中添加了证据水平和推荐等级。该指南的完整版本可在 EAU 办公室或网站 (www.uroweb.org) 上获得。
本文探讨了上述问题，通篇提到了医生和治疗团队的困境，以及需要告知和让患者参与到以缓解和康复为目标的协作经验方法中。这些问题在两个病例中得到了例证。
经过适当治疗后持续存在的慢性盆腔疼痛需要一种不同的方法，重点是疼痛。这种方法整合了医疗、心理社会和性关怀要素，让患者参与到自我管理的协作之旅中。
