Central changes associated with chronic pelvic pain and endometriosis.
Central changes associated with chronic pelvic pain and endometriosis.
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DOI：
10.1093/humupd/dmu025
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发表时间：
2014-09
影响因子：
13.3
通讯作者：
Vincent K
中科院分区：
文献类型：
--
作者：
Brawn J;Morotti M;Zondervan KT;Becker CM;Vincent K
慢性骨盆疼痛（CPP）是一个重要的公共卫生问题，在英国有100万受影响的妇女。尽管许多病理与CPP相关，但所经历的疼痛通常与所确定的疾病程度不成比例，并且通常未发现病理（慢性盆腔疼痛综合征）。中枢神经系统（CNS）是疼痛体验的中心，并且慢性疼痛病症通常与CNS的结构和功能的改变相关。本综述描述了与CPP相关的中枢变化的现有证据。进行了详细的文献检索以识别相关论文，但这不是系统性综述。CPP与中枢变化相关，类似于在其他疼痛疾病中发现的变化。具体而言，这些包括，在行为和中枢反应的伤害性刺激的变化，大脑结构的变化（增加和减少特定的大脑区域的体积），改变活动的下丘脑-垂体-肾上腺轴和自主神经系统（ANS）和心理困扰。本文回顾的证据表明，与健康无痛女性相比，CPP与显著的中枢变化相关。此外，这些变化的存在有可能加剧症状，并使这些妇女更容易患上其他慢性病。这些发现支持在这些女性中使用针对中枢神经系统的辅助药物。
Chronic pelvic pain (CPP) is a significant public health problem with 1 million affected women in the UK. Although many pathologies are associated with CPP, the pain experienced is often disproportionate to the extent of disease identified and frequently no pathology is found (chronic pelvic pain syndrome). The central nervous system (CNS) is central to the experience of pain and chronic pain conditions in general are associated with alterations in both the structure and function of the CNS. This review describes the available evidence for central changes in association with conditions presenting with CPP. A detailed literature search was performed to identify relevant papers, however, this is not a systematic review. CPP is associated with central changes similar to those identified in other pain conditions. Specifically these include, alterations in the behavioural and central response to noxious stimulation, changes in brain structure (both increases and decreases in the volume of specific brain regions), altered activity of both the hypothalamic–pituitary–adrenal axis and the autonomic nervous system (ANS) and psychological distress. The evidence reviewed in this paper demonstrates that CPP is associated with significant central changes when compared with healthy pain-free women. Moreover, the presence of these changes has the potential to both exacerbate symptoms and to predispose these women to the development of additional chronic conditions. These findings support the use of adjunctive medication targeting the CNS in these women.