Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications
Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications
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DOI：
10.1093/humupd/dmq050
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发表时间：
2011-05-01
影响因子：
13.3
通讯作者：
Berkley, Karen J.
中科院分区：
文献类型：
--
作者：
Stratton, Pamela;Berkley, Karen J.
背景：许多临床医生和患者认为子宫内膜异位症相关疼痛是由于病变引起的。然而，因果关系仍然是一个谜，因为子宫内膜异位症引起的疼痛症状发生在没有子宫内膜异位症的妇女身上，因为疼痛症状和严重程度与病变特征相关性很差。大多数研究和评论都集中在病变上，而不是疼痛。本文从认识到疼痛的体验是由中枢神经系统（CNS）决定开始，重点介绍疼痛症状.方法：综合检索Pubmed、Medline和Embase，对慢性盆腔疼痛和子宫内膜异位症的基础和临床研究现状进行综述。这些信息由子宫内膜异位症领域的基础科学家和临床研究人员共同解释。我们的目标是开发新的方法来概念化子宫内膜异位症如何有助于疼痛症状的背景下，目前的治疗和生殖道。结果：子宫内膜异位症病变可以发展自己的神经供应，从而创造一个直接和双向的病变和中枢神经系统之间的相互作用。这种参与提供了一种机制，通过这种机制，动态和神经反应神经系统直接发挥作用，产生各种个体差异的疼痛，可以在一些妇女，成为独立的疾病本身.CONCLUSIONS：重大进展，提高认识和减轻疼痛的子宫内膜异位症可能会发生，如果重点改变病变疼痛。反过来，子宫内膜异位症如何影响中枢神经系统将最好在其他慢性疼痛条件下的机制的背景下进行检查。
BACKGROUND: Many clinicians and patients believe that endometriosis-associated pain is due to the lesions. Yet causality remains an enigma, because pain symptoms attributed to endometriosis occur in women without endometriosis and because pain symptoms and severity correlate poorly with lesion characteristics. Most research and reviews focus on the lesions, not the pain. This review starts with the recognition that the experience of pain is determined by the central nervous system (CNS) and focuses on the pain symptoms.METHODS: Comprehensive searches of Pubmed, Medline and Embase were conducted for current basic and clinical research on chronic pelvic pain and endometriosis. The information was mutually interpreted by a basic scientist and a clinical researcher, both in the field of endometriosis. The goal was to develop new ways to conceptualize how endometriosis contributes to pain symptoms in the context of current treatments and the reproductive tract.RESULTS: Endometriotic lesions can develop their own nerve supply, thereby creating a direct and two-way interaction between lesions and the CNS. This engagement provides a mechanism by which the dynamic and hormonally responsive nervous system is brought directly into play to produce a variety of individual differences in pain that can, in some women, become independent of the disease itself.CONCLUSIONS: Major advances in improving understanding and alleviating pain in endometriosis will likely occur if the focus changes from lesions to pain. In turn, how endometriosis affects the CNS would be best examined in the context of mechanisms underlying other chronic pain conditions.