Хроническая тазовая боль (ХТБ) встречается преимущественно у женщин и поэтому часто расценивается как симптом гинекологического заболевания. Между тем причины ХТБ обычно множественны, и ее формирование связано прежде всего с персистенцией эстрогензависимого воспаления и развитием периферической и центральной сенситизации нервной системы. Наличие эстрогензависимого воспаления объясняет, с одной стороны, женскую «привилегию» на боль, с другой – частое выявление эндометриоза у пациенток с ХТБ. В то же время актуализация проблемы ХТБ как главной цели лечения позволяет осуществить разумный выбор средств для улучшения качества жизни больных. Ключевые слова: хроническая тазовая боль, эндометриоз, воспалительные заболевания органов таза, синдром тазовой конгестии, комбинированные оральные контрацептивы.
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Chronic pelvic pain occurs mainly in women, and is therefore often regarded as a symptom of a gynecological disease. Meanwhile, the causes of chronic pelvic pain are usually multiple, and its formation is associated primarily with the persistence of estrogen-dependent inflammation and the development of peripheral and central sensitization of the nervous system. The presence of estrogen-dependent inflammation explains, on the one hand, the female privilege of pain, and, on the other hand, the frequent detection of endometriosis in patients with chronic pelvic pain. At the same time, the actualization of the problem of chronic pelvic pain as the main goal of treatment allows us to make a reasonable choice of means to improve the quality of life of patients. Key words: chronic pelvic pain, endometriosis, pelvic inflammatory diseases, pelvic lumbar syndrome, combined oral contraceptives.
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4. Coosemans A, Moerman P, Vergote I et al. Wilm`s tumor gene 1(WT1) over expression in neurons in deep endometriosis: a pilot study. Fertil Steril 2009; 91 (4): 1441–4.
5. Giamberardino MA. Women and visceral pain: are the reproductive organs the main protagonists? Minireview at the occasion of the “European week against pain in women 2007”. Eur J Pain 2008; 12 (3): 257–60.
6. Wiech K, Tracey I. Influence of negative emotions on pain: behavioral effects and neural mechanisms. Neuroimage 2009; 47: 987–94.
7. Craig KD, Versloot J, Goubert L et al. Perceiving pain in others: automatic and controlled mechanisms. Pain 2010; 11 (2): 101–8.
8. Yarell J, Giamberardino MA, Robert M, Nasr-Esfabani M. Bed-side testing for chronic pelvic pain: discriminating visceral from somatic pain. Pain Res Treat 2011; 11: 692–8.
9. Адамян Л.В., Сонова М.М., Тихонова Е.С. и др. Медицинские и социальные аспекты генитального эндометриоза. Проблемы репродукции. 2011; 6: 78–81. / Adamian L.V., Sonova M.M., Tikhonova E.S. i dr. Meditsinskie i sotsial'nye aspekty genital'nogo endometrioza. Problemy reproduktsii. 2011; 6: 78–81. [in Russian]
10. Chapron C, Santulli P, Steuli I et al. Endometriosis: causes of pain. Int J Gynecol Obstet 2012; 119: S177.
11. Адамян Л.В. Эндометриоз: диагностика, лечение и реабилитация. Федеральные рекомендации по ведению больных. М., 2013. / Adamian L.V. Endometrioz: diagnostika, lechenie i reabilitatsiia. Federal'nye rekomendatsii po vedeniiu bol'nykh. M., 2013. [in Russian]
12. Carmona F, Chapron C, Martínez-Zamora MÁ. Ovarian endometrioma but not deep infiltrating endometriosis is associated with increased serum levels of interleukin-8 and interleukin-6. J Reprod Immunol 2012; 1–2: 80–6.
13. Nisenblat V, Bossuyt PM, Shaikh R. Blood biomarkers for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev 2016; Issue 5.
14. Ognong-Boulemo A, Dohan A, Hoeffel C et al. Adnexal masses associated with peritoneal involvement: diagnosis with CT and MRI. Abdom Radiol (NY) 2017. [Epub ahead of print]
15. Kanté F, Belghiti J, Roseau G et al. Comparison of the accuracy of rectal endoscopic sonography and magnetic resonance imaging in the diagnosis of colorectal endometriosis. Gynecol Obstet Fertil Senol 2017; 3: 131–6.
16. Hoyos LR, Benacerraf B, Puscheck EE. Imaging in Endometriosis and Adenomyosis. Clin Obstet Gynecol 2017; 1: 27–37.
17. Hudelist G, Fritzer N, Thomas A et al. Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences. Hum Reprod 2012; 12: 3412–6.
18. Халимова Д.Р. Клинико-иммунологические особенности течения воспалительных заболеваний органов малого таза у девушек. Репродуктивное здоровье детей и подростков. 2011; 3: 51–60. / Khalimova D.R. Kliniko-immunologicheskie osobennosti techeniia vospalitel'nykh zabolevanii organov malogo taza u devushek. Reproduktivnoe zdorov'e detei i podrostkov. 2011; 3: 51–60. [in Russian]
19. Адамян Л.В., Сонова М.М., Логинова О.Н. и др. Сравнительный анализ эффективности диеногеста и лейпрорелина в комплексном лечении генитального эндометриоза. Проблемы репродукции. 2013; 4: 33–8. / Adamian L.V., Sonova M.M., Loginova O.N. i dr. Sravnitel'nyi analiz effektivnosti dienogesta i leiprorelina v kompleksnom lechenii genital'nogo endometrioza. Problemy reproduktsii. 2013; 4: 33–8. [in Russian]
20. Somigliana E, Berlanda N, Benaglia L. Surgical excision of endometriomas and ovarian reserve: a systematic review on serum antimüllerian hormone level modifications. Fertil Steril 2012; 6: 1531–8.
21. Garcia-Velasco JA, Somigliana E. Management of endometriomas in women requiring IVF: to touch or not to touch. Hum Reprod 2009; 3: 496–501.
22. Gelbaya TA, Gordts S, D'Hooghe T.M. Management of endometrioma prior to IVF: compliance with ESHRE guidelines. Reprod Biomed Online 2010; 3: 325–30.
23. Vercellini P, Frattaruolo MP, Somigliana E et al. Surgical versus low-dose progestin treatment for endometriosis-associated severe deep dyspareunia II: Effect on sexual functioning, psychological status and health-related quality of life. Hum Reprod 2013; 28 (5): 1221–30.
24. ACOG Practice Bulletin № 114. Management of endometriosis. Obstet Gynecol 2010; 116: 223–36.
25. Falcone T, Lebovic DI. Clinical management of endometriosis. Obstet Gynecol 2011; 118 (3): 691–705.
26. Leyland N, Casper R, Laberge Ph et al. Endometriosis: Diagnosis and Management. Clinical Practice Guideline. JOGC 2010; 32 (7): 1–27.
27. Vercellini P, Crosignani PG, Somigliana E et al. “Waiting for Godot”: a commonsense approach to the medical treatment of endometriosis. Hum Reprod 2011; 26 (1): 3–13.
28. Allen C, Hopewell S, Prentice A, Gregory D. Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis. Cochrane Database Syst Rev 2009; 2: CD004753.
29. Каратеев А.Е., Яхно Н.Н., Лазебник Л.Б. и др. Применение нестероидных противовоспалительных препаратов. Клинические рекомендации. М.: ИМА-ПРЕСС, 2009; с. 9. / Karateev A.E., Iakhno N.N., Lazebnik L.B. i dr. Primenenie nesteroidnykh protivovospalitel'nykh preparatov. Klinicheskie rekomendatsii. M.: IMA-PRESS, 2009; s. 9. [in Russian]
30. Caruso S, Iraci M, Cianci S et al. Comparative, open-label prospective study on the quality of life and sexual function of women affected by endometriosis-associated pelvic pain on 2 mg dienogest/30 µg ethinyl estradiol continuous or 21/7 regimen oral contraceptive. J Endocrinol Invest 2016; 8: 923–31.
31. Matsuzaki S, Canis M, Pouly J-L et al. Both GnRH agonist and continuous oral progestin treatments reduce the expression of the tyrosine kinase receptor B and mu-opioid receptor in deep infiltrating endometriosis. Hum Reprod 2007; 22 (1): 124–8.
32. Атаманчук И.Н. Гормональная контрацепция при эндометриозе. Мед. аспекты здоровья женщины. 2014; 7: 5–11. / Atamanchuk I.N. Gormonal'naia kontratseptsiia pri endometrioze. Med. aspekty zdorov'ia zhenshchiny. 2014; 7: 5–11. [in Russian]
33. Hughes E, Brown J, Collins JJ et al. Ovulation suppression for endometriosis. Cochrane Database Syst Rev 2007; 3: CD000155.
34. Harada T, Momoeda M, Taketani Y et al. Dienogest is as effective as intranasal busereline acetate for the relief of pain symptoms associated with endometriosis – a randomized, double-blind, multicenter, controlled trial. Fertil Steril 2009; 91 (3): 774–80.
35. Davis LJ, Kennedy SS, Moore J, Prentice A. Oral contraceptives for pain associated with endometriosis. Cochrane Database Syst Rev 2007; 3: CD001019.
36. Cheong Y, Tay P, Luk F et al. Laparoscopic surgery for endometriosis: how often do we need to reoperate? J Obstet Gynecol 2008; 28: 82–5.
37. Shakiba K, Bena JF, McGill KM et al. Surgical treatment of endometriosis: a 7-year follow up on the requirement for further surgery. Obstet Gynecol 2008; 111: 1285–92.
38. Harada T, Momoeda M, Taketani Y, Terekawa N. Low-dose oral contraceptive pill for dysmenorrhea associated with endometriosis: a placebo-controlled, double-blind, randomized trial. Fertil Steril 2008; 90: 1583–8.
39. Vercellini P, Somigliana E, Viganò P et al. Endometriosis: current and future medical therapies. Best Pract Res Clin Obstet Gynaecol 2008; 22: 275–306.
40. Somigliana E, Busnelli A, Benaglia L et al. Postoperative hormonal therapy after surgical excision of deep endometriosis. Eur J Obstet Gynecol Reprod Biol 2017; 209: 77–80.
41. Vercellini P, Somigliana E, Viganò P et al. Post-operative endometriosis recurrence: a plea for prevention based on pathogenetic, epidemiological and clinical evidence. Reprod Biomed Online 2010; 2: 259–65.
42. Harada T, Momoeda M, Terekawa N et al. Evaluation of a low-dose oral contraceptive pill for primary dysmenorrheal: a placebo-controlled, double-blind, randomized trial. Fertil Steril 2011; 95: 1928–31.
43. Taran FA, Stewart EA, Brucker S. Adenomyosis: Epidemiology, Risk Factors, Clinical Phenotype and Surgical and Interventional Alternatives to Hysterectomy. Geburtshilfe Frauenheilkd 2013; 9: 924–31.
44. Сперофф Л., Дарни Ф.Д. Клиническое руководство по контрацепции. Пер с англ. М.: БИНОМ, 2009. / Speroff L., Darni F.D. Klinicheskoe rukovodstvo po kontratseptsii. Per s angl. M.: BINOM, 2009. [in Russian]
45. Schindler AE. Non-contraceptive benefits of oral hormonal contraceptives. Int J Endocrinol Metab 2013; 1: 41–7.
46. Global Consensus of World Endometriosis Society. Montpellier. 25.03.2013.
47. Schweppe K-W. Long-term use of progestogens – effects on endometriosis, adenomiosis and myomas. Gynecol Endocrinol 2007; 23 (S1): 17–21.
48. Grandi G, Mueller M, Bersinger NA et al. Does dienogest influence the inflammatory response of endometriotic cells? A systematic review. Inflamm Res 2016; 3: 183–92.
49. Iacovides S, Avidon I, Baker FC. What we know about primary dysmenorrhea today: a critical review. Hum Reprod Update 2015; 6: 762–78.
50. Leonardo-Pinto JP, Benetti-Pinto CL, Cursino K. Dienogest and deep infiltrating endometriosis: The remission of symptoms is not related to endometriosis nodule remission. Eur J Obstet Gynecol Reprod Biol 2017; p. 108–11.
51. Zito G, Luppi S, Giolo E et al. Medical treatments for endometriosis-associated pelvic pain. Biomed Res Int 2014; p. 191–967.
________________________________________________
1. Gunter J. Neurobiology of chronic pelvic pain. In: Chronic Pelvic Pain, ed. P.Vercellini; London, UK: Blackwell Publishing, 2011: 1–6.
2. Vorob'eva O.V. Khronicheskie tazovye boli: fokus na miofastsial'nyi bolevoi sindrom myshts tazovogo dna. Consilium Medicum. 2012; 6 (14): 14–8. [in Russian]
3. Adamian L.V., Sukhikh G.T. Tekhnologii XXI veka v ginekologii. M.: Mediasfera, 2008; s. 248. [in Russian]
4. Coosemans A, Moerman P, Vergote I et al. Wilm`s tumor gene 1(WT1) over expression in neurons in deep endometriosis: a pilot study. Fertil Steril 2009; 91 (4): 1441–4.
5. Giamberardino MA. Women and visceral pain: are the reproductive organs the main protagonists? Minireview at the occasion of the “European week against pain in women 2007”. Eur J Pain 2008; 12 (3): 257–60.
6. Wiech K, Tracey I. Influence of negative emotions on pain: behavioral effects and neural mechanisms. Neuroimage 2009; 47: 987–94.
7. Craig KD, Versloot J, Goubert L et al. Perceiving pain in others: automatic and controlled mechanisms. Pain 2010; 11 (2): 101–8.
8. Yarell J, Giamberardino MA, Robert M, Nasr-Esfabani M. Bed-side testing for chronic pelvic pain: discriminating visceral from somatic pain. Pain Res Treat 2011; 11: 692–8.
9. Adamian L.V., Sonova M.M., Tikhonova E.S. i dr. Meditsinskie i sotsial'nye aspekty genital'nogo endometrioza. Problemy reproduktsii. 2011; 6: 78–81. [in Russian]
10. Chapron C, Santulli P, Steuli I et al. Endometriosis: causes of pain. Int J Gynecol Obstet 2012; 119: S177.
11. Adamian L.V. Endometrioz: diagnostika, lechenie i reabilitatsiia. Federal'nye rekomendatsii po vedeniiu bol'nykh. M., 2013. [in Russian]
12. Carmona F, Chapron C, Martínez-Zamora MÁ. Ovarian endometrioma but not deep infiltrating endometriosis is associated with increased serum levels of interleukin-8 and interleukin-6. J Reprod Immunol 2012; 1–2: 80–6.
13. Nisenblat V, Bossuyt PM, Shaikh R. Blood biomarkers for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev 2016; Issue 5.
14. Ognong-Boulemo A, Dohan A, Hoeffel C et al. Adnexal masses associated with peritoneal involvement: diagnosis with CT and MRI. Abdom Radiol (NY) 2017. [Epub ahead of print]
15. Kanté F, Belghiti J, Roseau G et al. Comparison of the accuracy of rectal endoscopic sonography and magnetic resonance imaging in the diagnosis of colorectal endometriosis. Gynecol Obstet Fertil Senol 2017; 3: 131–6.
16. Hoyos LR, Benacerraf B, Puscheck EE. Imaging in Endometriosis and Adenomyosis. Clin Obstet Gynecol 2017; 1: 27–37.
17. Hudelist G, Fritzer N, Thomas A et al. Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences. Hum Reprod 2012; 12: 3412–6.
18. Khalimova D.R. Kliniko-immunologicheskie osobennosti techeniia vospalitel'nykh zabolevanii organov malogo taza u devushek. Reproduktivnoe zdorov'e detei i podrostkov. 2011; 3: 51–60. [in Russian]
19. Adamian L.V., Sonova M.M., Loginova O.N. i dr. Sravnitel'nyi analiz effektivnosti dienogesta i leiprorelina v kompleksnom lechenii genital'nogo endometrioza. Problemy reproduktsii. 2013; 4: 33–8. [in Russian]
20. Somigliana E, Berlanda N, Benaglia L. Surgical excision of endometriomas and ovarian reserve: a systematic review on serum antimüllerian hormone level modifications. Fertil Steril 2012; 6: 1531–8.
21. Garcia-Velasco JA, Somigliana E. Management of endometriomas in women requiring IVF: to touch or not to touch. Hum Reprod 2009; 3: 496–501.
22. Gelbaya TA, Gordts S, D'Hooghe T.M. Management of endometrioma prior to IVF: compliance with ESHRE guidelines. Reprod Biomed Online 2010; 3: 325–30.
23. Vercellini P, Frattaruolo MP, Somigliana E et al. Surgical versus low-dose progestin treatment for endometriosis-associated severe deep dyspareunia II: Effect on sexual functioning, psychological status and health-related quality of life. Hum Reprod 2013; 28 (5): 1221–30.
24. ACOG Practice Bulletin № 114. Management of endometriosis. Obstet Gynecol 2010; 116: 223–36.
25. Falcone T, Lebovic DI. Clinical management of endometriosis. Obstet Gynecol 2011; 118 (3): 691–705.
26. Leyland N, Casper R, Laberge Ph et al. Endometriosis: Diagnosis and Management. Clinical Practice Guideline. JOGC 2010; 32 (7): 1–27.
27. Vercellini P, Crosignani PG, Somigliana E et al. “Waiting for Godot”: a commonsense approach to the medical treatment of endometriosis. Hum Reprod 2011; 26 (1): 3–13.
28. Allen C, Hopewell S, Prentice A, Gregory D. Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis. Cochrane Database Syst Rev 2009; 2: CD004753.
29. Karateev A.E., Iakhno N.N., Lazebnik L.B. i dr. Primenenie nesteroidnykh protivovospalitel'nykh preparatov. Klinicheskie rekomendatsii. M.: IMA-PRESS, 2009; s. 9. [in Russian]
30. Caruso S, Iraci M, Cianci S et al. Comparative, open-label prospective study on the quality of life and sexual function of women affected by endometriosis-associated pelvic pain on 2 mg dienogest/30 µg ethinyl estradiol continuous or 21/7 regimen oral contraceptive. J Endocrinol Invest 2016; 8: 923–31.
31. Matsuzaki S, Canis M, Pouly J-L et al. Both GnRH agonist and continuous oral progestin treatments reduce the expression of the tyrosine kinase receptor B and mu-opioid receptor in deep infiltrating endometriosis. Hum Reprod 2007; 22 (1): 124–8.
32. Atamanchuk I.N. Gormonal'naia kontratseptsiia pri endometrioze. Med. aspekty zdorov'ia zhenshchiny. 2014; 7: 5–11. [in Russian]
33. Hughes E, Brown J, Collins JJ et al. Ovulation suppression for endometriosis. Cochrane Database Syst Rev 2007; 3: CD000155.
34. Harada T, Momoeda M, Taketani Y et al. Dienogest is as effective as intranasal busereline acetate for the relief of pain symptoms associated with endometriosis – a randomized, double-blind, multicenter, controlled trial. Fertil Steril 2009; 91 (3): 774–80.
35. Davis LJ, Kennedy SS, Moore J, Prentice A. Oral contraceptives for pain associated with endometriosis. Cochrane Database Syst Rev 2007; 3: CD001019.
36. Cheong Y, Tay P, Luk F et al. Laparoscopic surgery for endometriosis: how often do we need to reoperate? J Obstet Gynecol 2008; 28: 82–5.
37. Shakiba K, Bena JF, McGill KM et al. Surgical treatment of endometriosis: a 7-year follow up on the requirement for further surgery. Obstet Gynecol 2008; 111: 1285–92.
38. Harada T, Momoeda M, Taketani Y, Terekawa N. Low-dose oral contraceptive pill for dysmenorrhea associated with endometriosis: a placebo-controlled, double-blind, randomized trial. Fertil Steril 2008; 90: 1583–8.
39. Vercellini P, Somigliana E, Viganò P et al. Endometriosis: current and future medical therapies. Best Pract Res Clin Obstet Gynaecol 2008; 22: 275–306.
40. Somigliana E, Busnelli A, Benaglia L et al. Postoperative hormonal therapy after surgical excision of deep endometriosis. Eur J Obstet Gynecol Reprod Biol 2017; 209: 77–80.
41. Vercellini P, Somigliana E, Viganò P et al. Post-operative endometriosis recurrence: a plea for prevention based on pathogenetic, epidemiological and clinical evidence. Reprod Biomed Online 2010; 2: 259–65.
42. Harada T, Momoeda M, Terekawa N et al. Evaluation of a low-dose oral contraceptive pill for primary dysmenorrheal: a placebo-controlled, double-blind, randomized trial. Fertil Steril 2011; 95: 1928–31.
43. Taran FA, Stewart EA, Brucker S. Adenomyosis: Epidemiology, Risk Factors, Clinical Phenotype and Surgical and Interventional Alternatives to Hysterectomy. Geburtshilfe Frauenheilkd 2013; 9: 924–31.
44. Speroff L., Darni F.D. Klinicheskoe rukovodstvo po kontratseptsii. Per s angl. M.: BINOM, 2009. [in Russian]
45. Schindler AE. Non-contraceptive benefits of oral hormonal contraceptives. Int J Endocrinol Metab 2013; 1: 41–7.
46. Global Consensus of World Endometriosis Society. Montpellier. 25.03.2013.
47. Schweppe K-W. Long-term use of progestogens – effects on endometriosis, adenomiosis and myomas. Gynecol Endocrinol 2007; 23 (S1): 17–21.
48. Grandi G, Mueller M, Bersinger NA et al. Does dienogest influence the inflammatory response of endometriotic cells? A systematic review. Inflamm Res 2016; 3: 183–92.
49. Iacovides S, Avidon I, Baker FC. What we know about primary dysmenorrhea today: a critical review. Hum Reprod Update 2015; 6: 762–78.
50. Leonardo-Pinto JP, Benetti-Pinto CL, Cursino K. Dienogest and deep infiltrating endometriosis: The remission of symptoms is not related to endometriosis nodule remission. Eur J Obstet Gynecol Reprod Biol 2017; p. 108–11.
51. Zito G, Luppi S, Giolo E et al. Medical treatments for endometriosis-associated pelvic pain. Biomed Res Int 2014; p. 191–967.
Авторы
И.В.Кузнецова*
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М.Сеченова» Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2
*ms.smith.ivk@gmail.com
________________________________________________
I.V.Kuznetsova*
I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2
*ms.smith.ivk@gmail.com