Dolor pélvico crónico/Chronic pelvic pain

Dolor crónico en endometriosis: una visión general


Chronic pelvic pain in endometriosis: an overview.
Triolo O, Laganà AS, Sturlese E.
Department of Pediatric, Gynecological, Microbiological and Biomedical Sciences, University of Messina - Messina, Italy.
Clin Med Res. 2013 Jun;5(3):153-63. doi: 10.4021/jocmr1288w. Epub 2013 Apr 23.
Abstract
Chronic pelvic pain (CPP) could be considered nowadays a deep health problem that challenges physicians all over the world. This because its aetiology is still unclear, the course of the disease could vary a lot among different patients and through time in the same patient, and the response to treatments is not every time successful. Among women who underwent laparoscopy for CPP, endometriosis is found in about 1/3 of the cases, while only 25% of women with histological confirmed endometriosis are asymptomatic. A wide range of variables may exert their influence on the resulting pain syndrome in endometriosis; for example, score according to American society for reproductive medicine (rASRM), size of the sub-peritoneal and pelvic wall implants, Douglas obliteration, previous surgery. It is widely accepted nowadays that central nervous system (CNS) and peripheral nervous system (PNS) seems to influence each other and this interconnection play a key role in pain modulation. Moreover, the phenomena induced by endometriosis in the pelvis, including the breakdown of peritoneal homeostasis and the induction of the production of proinflammatory and proangiogenic cytokines, are responsible of altered innervations and modulation of pain pathways in these patients. There are many proposed medical and surgical approach to treat this painful syndrome, although there is necessity of more efforts to create new non-invasive strategies that set a more accurate diagnosis of the causes of endometriotic-related CPP, and therefore facilitate its eradication.
KEYWORDS: Chronic pelvic pain, Diagnosis, Endometriosis, Medical treatment, Surgical treatment
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3651065/pdf/jocmr-05-153.pdf


Manejo óptimo del dolor pélvico crónico cíclico: un enfoque basado en evidencias y abordaje pragmático

Optimal management of chronic cyclical pelvic pain: an evidence-based and pragmatic approach.
Won HR, Abbott J.
Department of Endo-Gynecology, Royal Hospital for Women, Sydney, New South Wales, Australia.
Int J Womens Health. 2010 Aug 20;2:263-77. doi: 10.2147/IJWH.S7991.
Abstract
This article reviews the literature on management of chronic cyclical pelvic pain (CCPP). Electronic resources including Medline, PubMed, CINAHL, The Cochrane Library, Current Contents, and EMBASE were searched using MeSH terms including all subheadings and keywords: "cyclical pelvic pain", "chronic pain", "dysmenorrheal", "nonmenstrual pelvic pain", and "endometriosis". There is a dearth of high-quality evidence for this common problem. Chronic pelvic pain affects 4%-25% of women of reproductive age. Dysmenorrhea of varying degree affects 60% of women. Endometriosis is the commonest pathologic cause of CCPP. Other gynecological causes are adenomyosis, uterine fibroids, and pelvic floor myalgia, although other systems disease such as irritable bowel syndrome or interstitial cystitis may be responsible. Management options range from simple to invasive, where simple medical treatment such as the combined oral contraceptive pill may be used as a first-line treatment prior to invasive management. This review outlines an approach to patients with CCPP through history, physical examination, and investigation to identify the cause(s) of the pain and its optimal management.
KEYWORDS: chronic pain, cyclical pelvic pain, dysmenorrhea, endometriosis, nonmenstrual pelvic pain
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2990894/pdf/ijwh-2-263.pdf


Neuromodulación del dolor pélvico visceral: revisión de la literatura y serie de casos de manejo potencial sobre nuevas ¨dianas¨

Neuromodulation of Pelvic Visceral Pain: Review of the Literature and Case Series of Potential Novel Targets for Treatment
http://onlinelibrary.wiley.com/doi/10.1111/j.1533-2500.2012.00558.x/pdf



Tratamiento de pacientes con dolor pélvico crónico asociado a endometriosis refractaria al manejo convencional

Management of Patients with Chronic Pelvic Pain Associated with Endometriosis Refractory to Conventional Treatment
http://onlinelibrary.wiley.com/doi/10.1111/j.1533-2500.2012.00559.x/pdf





Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org