New concepts on functional chronic pelvic and perineal pain: pathophysiology and multidisciplinarymanagement.
Abstract
The management of chronic pelvic and perineal pain has been improved by a better understanding of the mechanisms of this pain and an optimized integrated multidisciplinary approach to the patient.
The concept of organic lesions responsible for a persistent nociceptive factor has gradually been replaced by that of dysregulation of nociceptive messages derived from the pelvis and perineum.
In this setting, painful diseases identified by organ specialists are usually also involved and share several common denominators (triggering factors, predisposing clinical context).
These diseases include painful bladder syndrome, irritable bowel syndrome, vulvodynia, and chronic pelvic pain syndrome.
The painful symptoms vary from one individual to another and according to his or her capacity to activate pain inhibition/control processes.
Although the patient often attributes chronicpain to a particular organ (with the corollary that pain will persist until the organ has been treated), this pain is generally no longer derived from the organ but is expressed via this organ.
Several types of clinical presentation of complex
pelvic pain have therefore been pragmatically identified to
facilitate the management of treatment failures resulting from
a purely organ-based approach, which can also reinforce the
patient's impression of incurability.
These subtypes correspond to Neuropathic pain, Central
sensitization (fibromyalgia), Complex
regional pain syndrome, and Emotional components similar
to those observed in post-traumatic stress disorder.
These various components are also often associated and
Consequently, when pelvic pain cannot be explained by an
organ disease, this model, using each of these four
components associated with their specific mechanisms, can
be used to propose personalized treatment options and also
to identify patients at high risk of postoperative
pelvic pain(multi-operated patients, central sensitization,
post-traumatic stress disorder, etc.), which constitutes a
major challenge for prevention of these types of pain that
have major implications for patients and society.
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