Dellenbach P, Haeringer M T
Service de Gynécologie-Obstétrique, Centre médico-chirurgical et obstétrical de la Sécurité sociale, Schiltigheim.
Presse Med. 1996 Apr 13;25(13):615-20.
Chronic pelvic pain (CPP) is one of the most difficult and perplexing problems encountered in gynecology. Lately CPP has been attributed, among many other etiologies to tension myalgia of the pelvic floor. Identification of trigger points, myofascial problems and the Carnett test have been considered helpful. We hypothesized that these are not the cause of CPP but a sign of psychic disturbance.
Seventy patients, 40 with CPP, 20 with organic pain and 10 normal controls were investigated. A pain index was defined and used. A blinded psychologic evaluation was conducted in all cases using the Rorschach and a semi structured psychologic interview. A psychometric index was calculated.
The algometric test was low in controls. It was in the higher range in CPP patients and in both cases correlated well with the psychometric index. CPP patients expressed a variety of psychic disturbances. The response of patients with organic CPP to etiologic treatment could be predicted by the algometric index, low index = good response; high index = difficult follow up.
Trigger points, tension myalgia and abdominal cellulalgia are not the cause of CPP. They are the sign of somatization of neurotic or psychosomatic problems in the pelvis. They represent a useful diagnostic tool, which will allow an individualized, multidisciplinary approach to diagnosis and management of CPP.
慢性盆腔疼痛（CPP）是妇科中遇到的最困难和最复杂的问题之一。最近，在许多其他病因中，CPP被归因于盆底紧张性肌痛。触发点、肌筋膜问题和卡内特试验被认为是有帮助的。我们假设这些不是CPP的原因，而是精神障碍的迹象。
对70名患者进行了调查，其中40名患有CPP，20名患有器质性疼痛，10名作为正常对照。定义并使用了疼痛指数。在所有病例中，使用罗夏墨迹测验和半结构化心理访谈进行了盲法心理评估。计算了心理测量指数。
对照组的痛觉测量试验值较低。CPP患者的该值处于较高范围，且在这两种情况下均与心理测量指数密切相关。CPP患者表现出各种精神障碍。器质性CPP患者对病因治疗的反应可以通过痛觉测量指数来预测，指数低 = 反应良好；指数高 = 随访困难。
触发点、紧张性肌痛和腹部纤维肌痛不是CPP的原因。它们是骨盆中神经症或心身问题躯体化的迹象。它们是一种有用的诊断工具，将有助于对CPP进行个体化、多学科的诊断和管理。
