Institute of Surgical Pathology, Department of Medical, Oral and Biotechnological Sciences, "G D'Annunzio" University of Chieti, Chieti, Italy.
Geriatrics Clinic, Department of Medicine and Science of Aging, "G D'Annunzio" University of Chieti, Chieti, Italy.
Eur J Pain. 2020 May;24(5):933-944. doi: 10.1002/ejp.1542. Epub 2020 Mar 4.
Women with dysmenorrhoea plus symptomatic urinary calculosis experience enhanced pain and referred muscle hyperalgesia from both conditions than women with one condition only (viscero-visceral hyperalgesia). The study aimed at verifying if enhanced dysmenorrhoea persists after urinary stone elimination in comorbid women and if local anaesthetic inactivation of myofascial trigger points (TrPs) in the lumbar area (of urinary pain referral) also relieves dysmenorrhoea.
Thirty-one women with dysmenorrhoea plus previous urinary calculosis (Dys+PrCal) and lumbar TrPs, and 33 women with dysmenorrhoea without calculosis (Dys) underwent a 1-year assessment of menstrual pain and muscle hyperalgesia in the uterus-referred area (electrical pain threshold measurement in rectus abdominis, compared with thresholds of 33 healthy controls). At the end of the year, 16 comorbid patients underwent inactivation of TrPs through anaesthetic injections, whereas the remaining 12 received no TrP treatment. Both groups were monitored for another year at the end of which thresholds were re-measured.
In year1, Dys+PrCal presented significantly more painful menstrual cycles and lower abdominal thresholds than Dys, thresholds of both groups being significantly lower than normal (p < .001). Anaesthetic treatment versus no treatment of the lumbar TrP significantly reduced the number of painful cycles during year2 and significantly increased the abdominal thresholds (p < .0001).
Viscero-visceral hyperalgesia between uterus and urinary tract may persist after stone elimination due to nociceptive inputs from TrPs in the referred urinary area, since TrPs treatment effectively reverses the enhanced menstrual symptoms. The procedure could represent an integral part of the management protocol in these conditions.
A past pain process from an internal organ can continue enhancing pain expression from a painful disease in another neuromerically connected organ (viscero-visceral hyperalgesia) if secondary myofascial trigger points (TrPs) developed in the referred area at the time of the previous visceral disease. Inactivation of these TrPs reverts the enhancement. Assessment and treatment of TrPs in referred areas from past visceral pain conditions should be systematically carried out to better control pain from current diseases in other viscera.
患有痛经和症状性尿路结石的女性比仅患有一种疾病的女性（内脏-内脏痛觉过敏）经历的疼痛和牵涉性肌肉痛觉过敏更强。本研究旨在验证在合并症女性中，尿路结石消除后是否仍存在痛经加重，以及在腰部（尿路疼痛牵涉区）的肌筋膜触发点（TrPs）局部麻醉失活是否也能缓解痛经。
31 名患有痛经加以前尿路结石（Dys+PrCal）和腰部 TrPs 的女性和 33 名患有痛经无结石（Dys）的女性接受了 1 年的月经疼痛和子宫牵涉区肌肉痛觉过敏评估（腹直肌电痛阈测量，与 33 名健康对照者的阈值比较）。在 1 年后，16 名合并症患者接受了 TrPs 的麻醉注射失活治疗，而其余 12 名患者未接受 TrP 治疗。两组在结束时再监测一年，结束时再次测量阈值。
在第 1 年，Dys+PrCal 的月经周期疼痛明显更剧烈，腹部阈值明显更低，两组的阈值均明显低于正常值（p<0.001）。与不治疗腰部 TrP 相比，麻醉治疗显著减少了第 2 年的疼痛周期数，并显著增加了腹部阈值（p<0.0001）。
由于在牵涉性尿路区域的 TrPs 产生的伤害性传入，在结石消除后，子宫和尿路之间的内脏-内脏痛觉过敏可能会持续存在，因为 TrPs 治疗有效地逆转了增强的月经症状。该程序可能是这些情况下管理方案的一个组成部分。
来自内部器官的过去疼痛过程可以继续增强另一个神经连接的器官（内脏-内脏痛觉过敏）的疼痛疾病的疼痛表达，如果在前一次内脏疾病时在牵涉区发展了二级肌筋膜触发点（TrPs）。这些 TrPs 的失活逆转了增强。应系统地评估来自过去内脏疼痛状况的牵涉区的 TrPs 并进行治疗，以更好地控制其他内脏当前疾病的疼痛。
