Mechanizm powstawania oraz sposoby leczenia przewlekłego bólu trzewnego w chorobach wywodzących się z żeńskich narządów rodnych

Sylwester Mordarski

Streszczenie
Women with chronic pain of the pelvic cavity complain about deep pain either unilateral, bilateral or in the midline, often radiating to the low back, anterior abdominal wall, buttock, hips, and anterior thighs. Pelvic pain can be cyclic (related to menstrual cycle), intermittent or continuous. Chronic pelvic pain is often thought to be primarily of gynecologic origin. However, all other structures in the pelvic cavity including the urinary tract, the lower gastrointestinal tract and the pelvic blood vessels have to be included in the differential diagnosis. Other etiologies to be considered include the musculoskeletal system, a neurologic problem and psychiatric etiologies. Thus the differential diagnosis is complicated and a thorough work-up is necessary.
Several different pharmacological classes of medications have been demonstrated to be effective in alleviating pain in patients with chronic pain syndromes: NSAIDs, antidepressants, anticonvulsants, local anesthetic antiarrhytmics and opioids. Adequate trials should be performed for each drug prescribed and only one drug should be titrated at a time. Over the last years regional anesthesia techniques has been a new interest in neurolytic superior hypogastric plexus block for the treatment of chronic pelvic pain associated with cancer. Analgesia after neurolytic blockade of the superior hypogastric plexus might be due to interruption of the sympathetic outflow to the pelvic organs.

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