Gutke Annelie, Sundfeldt Karin, De Baets Liesbet
Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 40350 Gothenburg, Sweden.
Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 40350 Gothenburg, Sweden.
J Clin Med. 2021 Nov 19;10(22):5397. doi: 10.3390/jcm10225397.
During their lifespan, many women are exposed to pain in the pelvis in relation to menstruation and pregnancy. Such pelvic pain is often considered normal and inherently linked to being a woman, which in turn leads to insufficiently offered treatment for treatable aspects related to their pain experience. Nonetheless, severe dysmenorrhea (pain during menstruation) as seen in endometriosis and pregnancy-related pelvic girdle pain, have a high impact on daily activities, school attendance and work ability. In the context of any type of chronic pain, accumulating evidence shows that an unhealthy lifestyle is associated with pain development and pain severity. Furthermore, unhealthy lifestyle habits are a suggested perpetuating factor of chronic pain. This is of specific relevance during lifespan, since a low physical activity level, poor sleep, or periods of (di)stress are all common in challenging periods of women's lives (e.g., during menstruation, during pregnancy, in the postpartum period). This state-of-the-art paper aims to review the role of lifestyle factors on pain in the pelvis, and the added value of a lifestyle intervention on pain in women with pelvic pain. Based on the current evidence, the benefits of physical activity and exercise for women with pain in the pelvis are supported to some extent. The available evidence on lifestyle factors such as sleep, (di)stress, diet, and tobacco/alcohol use is, however, inconclusive. Very few studies are available, and the studies which are available are of general low quality. Since the role of lifestyle on the development and maintenance of pain in the pelvis, and the value of lifestyle interventions for women with pain in the pelvis are currently poorly studied, a research agenda is presented. There are a number of rationales to study the effect of promoting a healthy lifestyle (early) in a woman's life with regard to the prevention and management of pain in the pelvis. Indeed, lifestyle interventions might have, amongst others, anti-inflammatory, stress-reducing and/or sleep-improving effects, which might positively affect the experience of pain. Research to disentangle the relationship between lifestyle factors, such as physical activity level, sleep, diet, smoking, and psychological distress, and the experience of pain in the pelvis is, therefore, needed. Studies which address the development of management strategies for adapting lifestyles that are specifically tailored to women with pain in the pelvis, and as such take hormonal status, life events and context, into account, are required. Towards clinicians, we suggest making use of the window of opportunity to prevent a potential transition from localized or periodic pain in the pelvis (e.g., dysmenorrhea or pain during pregnancy and after delivery) towards persistent chronic pain, by promoting a healthy lifestyle and applying appropriate pain management.
在一生中，许多女性会经历与月经和怀孕相关的盆腔疼痛。这种盆腔疼痛通常被认为是正常的，并且与女性身份有着内在联系，这反过来导致对于她们疼痛经历中可治疗方面的治疗不足。然而，子宫内膜异位症中出现的严重痛经（经期疼痛）以及与怀孕相关的骨盆带疼痛，对日常活动、上学出勤率和工作能力都有很大影响。在任何类型的慢性疼痛背景下，越来越多的证据表明不健康的生活方式与疼痛的发生和严重程度有关。此外，不健康的生活习惯被认为是慢性疼痛的一个持续因素。这在女性的一生中具有特殊的相关性，因为在女性生活的挑战时期（例如经期、孕期、产后），身体活动水平低、睡眠质量差或处于（情绪）压力期都是常见的。这篇综述文章旨在探讨生活方式因素对盆腔疼痛的作用，以及生活方式干预对盆腔疼痛女性疼痛状况改善的附加价值。基于目前的证据，身体活动和锻炼对盆腔疼痛女性的益处得到了一定程度的支持。然而，关于睡眠、（情绪）压力、饮食以及烟草/酒精使用等生活方式因素的现有证据尚无定论。相关研究非常少，而且现有研究的质量普遍较低。由于目前对生活方式在盆腔疼痛发生和维持中的作用以及生活方式干预对盆腔疼痛女性的价值研究不足，本文提出了一个研究议程。有许多理由去研究在女性生活早期促进健康生活方式对于预防和管理盆腔疼痛的效果。事实上，生活方式干预可能具有抗炎、减轻压力和/或改善睡眠等作用，这可能会对疼痛体验产生积极影响。因此，需要开展研究来厘清身体活动水平、睡眠、饮食、吸烟和心理困扰等生活方式因素与盆腔疼痛体验之间的关系。还需要开展研究来制定针对盆腔疼痛女性的、考虑到激素状态、生活事件和背景的个性化生活方式调整管理策略。对于临床医生，我们建议利用这个时机，通过促进健康生活方式和应用适当的疼痛管理方法，预防盆腔局部或周期性疼痛（例如痛经、孕期和产后疼痛）向持续性慢性疼痛的潜在转变。
