Vij Monika, Davies Anthony, Dua Anu, Freeman Robert
Derriford Hospital, Plymouth, UK.
Singleton Hospital, Swansea, Wales, UK.
Int Urogynecol J. 2019 Mar;30(3):483-488. doi: 10.1007/s00192-018-3709-0. Epub 2018 Jul 4.
Patients in gynecology outpatient clinics (GOPDs) may present with symptoms that do not correlate well with the observed pathology and are usually labelled as having a functional disorder or medically unexplained symptoms (MUS). Underlying central sensitivity syndrome (CSS) with central sensitization (CS) as a potential mechanism may be responsible for some of their symptoms. The aim of this study is to identify the proportion of women with central sensitivity syndrome attending GOPDs.
This was a prospective study. All women attending a GOPD included in the study were asked to complete a validated Central Sensitization Inventory (CSI). The responses were graded on a Likert scale from 0 (never) to 4 (always). The total score ranges from 0 to 100. For screening purposes, a single CSI cutoff score of 40 was used to identify the group of women who may have central sensitization syndrome.
Three hundred twenty-six women participated in the study. Overall, 123 (37%) women achieved a score above 40. This could be interpreted as these patients having increased risk of underlying central sensitization. Of these, 43 had a previously confirmed diagnosis of migraine, 55 (44%) depression, 39 (31.7%) anxiety, 11 fibromyalgia (FM), 34 irritable bowel syndrome (IBS) and 16 chronic fatigue syndrome (CFS/ME).
Managing patients and their expectations in gynecological outpatient departments when symptoms are inconsistent with observable pathological findings is challenging. This is further complicated when patients have a concomitant central sensitivity syndrome, which can also influence the surgical outcome. Identifying these patients is a key factor for appropriate management.
妇科门诊（GOPD）患者可能出现与观察到的病理情况相关性不佳的症状，这些症状通常被归类为功能性障碍或医学上无法解释的症状（MUS）。潜在的以中枢敏化（CS）为机制的中枢敏感综合征（CSS）可能是其部分症状的原因。本研究的目的是确定在妇科门诊就诊的患有中枢敏感综合征的女性比例。
这是一项前瞻性研究。要求纳入研究的所有在妇科门诊就诊的女性完成一份经过验证的中枢敏化量表（CSI）。回答按照李克特量表从0（从不）到4（总是）进行评分。总分范围为0至100。为了进行筛查，使用单一的CSI临界值40来确定可能患有中枢敏化综合征的女性群体。
326名女性参与了该研究。总体而言，123名（37%）女性得分高于40。这可以解释为这些患者存在潜在中枢敏化风险增加的情况。其中，43名曾被确诊患有偏头痛，55名（44%）患有抑郁症，39名（31.7%）患有焦虑症，11名患有纤维肌痛（FM），34名患有肠易激综合征（IBS），16名患有慢性疲劳综合征（CFS/ME）。
当妇科门诊患者的症状与可观察到的病理结果不一致时，管理患者及其期望具有挑战性。当患者同时患有中枢敏感综合征时，情况会更加复杂，这也会影响手术结果。识别这些患者是进行适当管理的关键因素。
