Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, UK Department of Obstetrics and Gynaecology, University of Genoa, Genoa 16100, Italy.
Hum Reprod Update. 2014 Sep-Oct;20(5):737-47. doi: 10.1093/humupd/dmu025. Epub 2014 Jun 11.
Chronic pelvic pain (CPP) is a significant public health problem with 1 million affected women in the UK. Although many pathologies are associated with CPP, the pain experienced is often disproportionate to the extent of disease identified and frequently no pathology is found (chronic pelvic pain syndrome). The central nervous system (CNS) is central to the experience of pain and chronic pain conditions in general are associated with alterations in both the structure and function of the CNS. This review describes the available evidence for central changes in association with conditions presenting with CPP.
A detailed literature search was performed to identify relevant papers, however, this is not a systematic review.
CPP is associated with central changes similar to those identified in other pain conditions. Specifically these include, alterations in the behavioural and central response to noxious stimulation, changes in brain structure (both increases and decreases in the volume of specific brain regions), altered activity of both the hypothalamic-pituitary-adrenal axis and the autonomic nervous system (ANS) and psychological distress.
The evidence reviewed in this paper demonstrates that CPP is associated with significant central changes when compared with healthy pain-free women. Moreover, the presence of these changes has the potential to both exacerbate symptoms and to predispose these women to the development of additional chronic conditions. These findings support the use of adjunctive medication targeting the CNS in these women.
慢性盆腔疼痛（CPP）是一个重大的公共健康问题，在英国有 100 万女性受到影响。尽管许多病理学与 CPP 有关，但所经历的疼痛往往与所确定的疾病程度不成比例，而且经常没有发现病理学（慢性盆腔疼痛综合征）。中枢神经系统（CNS）是疼痛体验的核心，一般来说，慢性疼痛状况与 CNS 的结构和功能改变有关。这篇综述描述了与 CPP 相关的与中枢变化相关的现有证据。
进行了详细的文献检索以确定相关论文，但这不是系统评价。
CPP 与其他疼痛状况中发现的中枢变化有关。具体而言，这些变化包括对有害刺激的行为和中枢反应的改变、大脑结构的变化（特定脑区的体积增加和减少）、下丘脑-垂体-肾上腺轴和自主神经系统（ANS）的活动改变以及心理困扰。
本文综述的证据表明，与健康无痛女性相比，CPP 与显著的中枢变化有关。此外，这些变化的存在有可能加剧症状，并使这些女性更容易患上其他慢性疾病。这些发现支持在这些女性中使用针对中枢神经系统的辅助药物。
