Taylor Robert N, Hummelshoj Lone, Stratton Pamela, Vercellini Paolo
Department of Obstetrics and Gynecology, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC, USA.
Middle East Fertil Soc J. 2012 Dec 1;17(4):221-225. doi: 10.1016/j.mefs.2012.09.002.
The association of pain and endometriosis was recognized with the first definitive published reports of this disorder. Unfortunately, the precise etiologies and pathways leading to nociception and pain symptoms in endometriosis remain poorly understood, and as a result, effective therapeutic interventions are lacking with consequent profound effects on affected women's quality of life. In this opinion paper we summarize selected proceedings presented at the 28th Annual Meeting of the European Society of Human Reproduction and Embryology (ESHRE) in Istanbul, Turkey, and review the clinical and translational evidence of chronic pain, neurogenesis, and the pernicious impact of dyspareunia on women with symptomatic endometriosis. The effectiveness of medical treatments is critically assessed and the findings indicate that good therapeutic options are available with extant medications effective in some sub-groups of women with endometriosis, many of which are affordable globally. Nevertheless, new management strategies and drugs need to be developed to increase the options of all afflicted women to minimize and ideally eradicate painful symptoms of endometriosis. However, only by elucidating distinctions among sub-groups with specific symptoms, suggesting different mechanisms, are we likely to derive truly successful therapeutic strategies.
疼痛与子宫内膜异位症的关联在关于这种疾病的首批权威发表报告中就已得到确认。遗憾的是，导致子宫内膜异位症中伤害感受和疼痛症状的确切病因及途径仍知之甚少，因此，缺乏有效的治疗干预措施，这对患病女性的生活质量产生了深远影响。在这篇观点论文中，我们总结了在土耳其伊斯坦布尔举行的第28届欧洲人类生殖与胚胎学会（ESHRE）年会上展示的部分会议论文，并回顾了慢性疼痛、神经发生以及性交困难对有症状的子宫内膜异位症女性的有害影响的临床及转化证据。对医学治疗的有效性进行了严格评估，结果表明，现有药物对部分子宫内膜异位症女性亚组有效，有不错的治疗选择，其中许多药物在全球范围内都负担得起。然而，需要开发新的管理策略和药物，以增加所有患病女性的选择，尽量减少并理想地消除子宫内膜异位症的疼痛症状。不过，只有通过阐明具有特定症状的亚组之间的差异，提出不同的机制，我们才有可能得出真正成功的治疗策略。
