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一个疼痛脱敏算法用于表型化和治疗慢性盆腔疼痛

Liane Silva Rafael Rogério¹, Maurice K Chung², Charles W Butrick³

¹Clínica Aurora, Manaus, Amazonas, Brazil.

JSLS : Journal of the Society of Laparoendoscopic Surgeons

|September 18, 2024

概括

一个新的算法通过通过神经阻塞和静脉内疗法引导治疗来简化慢性骨盆疼痛的管理,显著改善了患者的疼痛评分和生活质量.

科学领域:

疼痛管理疼痛管理
泌尿器科泌尿器科泌尿器科泌尿器科
神经学神经学

背景情况:

慢性盆腔疼痛 (CPP) 由于中心/外周敏感化和多种疼痛发生器 (膀,盆底,骨盆神经) 而带来管理挑战.
神经阻塞已成为疼痛管理提供者的诊断和治疗工具.
开发了一种新的脱敏算法,以提供CPP管理的逐步方法.

研究的目的:

评估一种新的脱敏算法的有效性,以改善慢性盆腔疼痛患者的疼痛得分.
评估通过麻醉挑战测试 (ACT) 引导的静脉内疗法和尾神经阻塞的结果.

主要方法:

一项前性观察队列研究包括182名女性 (15-90岁) 在2016-2018年期间患有CPP.
该算法以膀的麻醉挑战测试 (ACT) 启动.
根据ACT结果,治疗进展到静脉内疗法和/或尾神经阻塞.

主要成果:

在接受静脉内治疗的ACT POSITIVE患者中,84%的患者经历了≥50%的视觉模拟尺度疼痛改善,64%的患者实现了≥80%的改善 (41%的无疼痛).
接下来接受布登达尔阻塞的患者显示83%,改善≥50% (67%无疼痛).
经过布登达尔阻塞的患者在80%的患者中获得了≥50%的缓解,在65%的患者中获得了≥80%的改善 (35%无疼痛). 所有结果都具有统计学意义 (P < .05).

结论:

开发的算法简化了CPP的管理,通常涉及多个疼痛发生器.
这种逐步的方法有效地减少了疼痛的严重程度,可能会在手术之前进行手术.
该算法在疼痛得分上显著改善,为复杂的骨盆疼痛病例提供了结构化的治疗途径.

关键词:

中央神经系统敏感化敏感化慢性盆腔疼痛慢性盆腔疼痛在子宫内膜异位症的疼痛.间歇性囊炎间歇性囊炎肌筋关节疼痛肌筋关节疼痛疼痛的膀综合征疼痛的膀综合征尾神经的疼痛是一种神经性疼痛.

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