Marks Stephanie K, Rodriguez Nathan A, Shah Anisha, Garcia Andi N, Ritter Leah, Pierce Angela N
Curriculum & Integrated Learning, College of Osteopathic Medicine, Kansas City University, Kansas City, USA.
Curriculum & Integrated Learning, College of Osteopathic Medicine, Kansas City University, Joplin, USA.
Cureus. 2022 Jul 20;14(7):e27077. doi: 10.7759/cureus.27077. eCollection 2022 Jul.
Chronic pelvic pain syndrome (CPPS) is a functional pain disorder characterized by ongoing pain in the apparent absence of clinically identifiable causes. The prevalence of functional pain disorders demonstrates the importance of adequate management of ongoing symptomatology, but due to the uncertain etiology and myriad patient presentation phenotypes, reliable treatment options are difficult to implement. New interventions involving non-pharmacological approaches to pain management have been investigated across a spectrum of clinical and pre-clinical studies. Given that conservative care such as exercise, counseling, and musculoskeletal therapy is widely recommended as first-line treatment for CPPS, an updated review of these and related methodologies are needed. Familiarizing physicians and the public with the newest evidence for complementary and alternative medicine (CAM) and other conservative care treatments will assist with the promotion of evidence-based practices in a safe and reliable manner. This review aimed to summarize the current evidence and proposed mechanisms for non-pharmacological treatment specific to CAM and management of chronic pelvic pain centered on neuromusculoskeletal focused intervention such as acupuncture, auriculotherapy, manipulation, manual therapy, myofascial release, and phototherapy. The discussion suggests that reported improvements in pelvic pain or related symptomatology may be attributed to changes in the peripheral inflammasome and somatic origins of peripheral sensitization. Robustness of the included clinical studies is discussed throughout the review, and attention is paid to delineating inclusion criteria of formally diagnosed CPPS compared to general pelvic or abdominal pain. Overall, this review consolidates the current state of evidence regarding the utilization of non-traditional interventions using CAM techniques for the management of chronic pelvic pain and recommends a future direction for the field.
慢性盆腔疼痛综合征（CPPS）是一种功能性疼痛障碍，其特征是在明显没有临床可识别病因的情况下持续疼痛。功能性疼痛障碍的患病率表明了充分管理持续症状的重要性，但由于病因不明且患者表现型众多，难以实施可靠的治疗方案。在一系列临床和临床前研究中，已经对涉及非药物疼痛管理方法的新干预措施进行了研究。鉴于运动、咨询和肌肉骨骼治疗等保守治疗被广泛推荐为CPPS的一线治疗方法，因此需要对这些方法及相关方法进行更新综述。让医生和公众熟悉补充和替代医学（CAM）及其他保守治疗的最新证据，将有助于以安全可靠的方式推广循证实践。本综述旨在总结目前关于CAM特定非药物治疗以及以神经肌肉骨骼聚焦干预（如针灸、耳针疗法、手法治疗、手动疗法、肌筋膜松解和光疗）为中心的慢性盆腔疼痛管理的证据和提出的机制。讨论表明，报告的盆腔疼痛或相关症状的改善可能归因于外周炎性小体的变化和外周敏化的躯体起源。在整个综述中讨论了纳入临床研究的稳健性，并注意区分正式诊断的CPPS与一般盆腔或腹部疼痛的纳入标准。总体而言，本综述巩固了关于使用CAM技术的非传统干预措施治疗慢性盆腔疼痛的现有证据状态，并为该领域推荐了未来的方向。
