针灸在子宫内膜异位症疼痛或“子宫内膜痛”中是否有作用?

Thomas Lundeberg, Iréne Lund
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引用次数: 22

摘要

子宫内膜异位症是女性骨盆疼痛的常见原因,许多人在月经期间会出现一系列症状。症状可能包括异常内脏感觉和情绪困扰的组合。子宫内膜异位症疼痛或“子宫内膜痛”通常对工作能力、家庭关系和价值感产生负面影响。子宫内膜痛通常被认为是一种同质的感觉实体,由一个专门的高阈值感觉系统介导,该系统从外周通过脊髓、脑干和丘脑延伸到大脑皮层。然而,在神经系统中已经发现了导致疼痛的多种机制,包括外周致敏、表型开关、中枢致敏、异位兴奋性、结构重组、抑制降低和促进增加,所有这些都可能导致疼痛。虽然引起子宫内膜痛的原因各不相同(如炎症性、神经性和功能性),但它们有一些共同的特点。子宫内膜痛可能由低强度、通常无害的刺激(异常性痛觉)引起,也可能是对有害刺激(痛觉过敏)的夸大和长期反应。在没有明显外周刺激的情况下,疼痛也可能是自发的。雌激素和前列腺素可能在子宫内膜异位症和子宫内膜痛中起关键的调节作用。因此,目前许多治疗这种疾病的药物包括口服药物,如非类固醇抗炎药、避孕药、孕激素、雄激素药物、促性腺激素释放激素类似物,以及腹腔镜手术切除子宫内膜异位症病变。然而,对于许多患有子宫内膜异位症的妇女来说,目前对疼痛的管理是不够的。可能针灸和认知疗法可以作为辅助疗法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Is there a role for acupuncture in endometriosis pain, or 'endometrialgia'?

Endometriosis is a common cause of pelvic pain in women, many of whom suffer a progression of symptoms over their menstrual life. Symptoms may include combinations of abnormal visceral sensations and emotional distress. Endometriosis pain, or 'endometrialgia' often has a negative influence on the ability to work, on family relationships and sense of worth. Endometrialgia is often considered to be a homogeneous sensory entity, mediated by a specialised high threshold sensory system, which extends from the periphery through the spinal cord, brain stem and thalamus to the cerebral cortex. However, multiple mechanisms have been detected in the nervous system responsible for the pain including peripheral sensitisation, phenotypic switches, central sensitisation, ectopic excitability, structural reorganisation, decreased inhibition and increased facilitation, all of which may contribute to the pain. Although the causes of endometrialgia can differ (eg inflammatory, neuropathic and functional), they share some characteristics. Endometrialgia may be evoked by a low intensity, normally innocuous stimulus (allodynia), or it may be an exaggerated and prolonged response to a noxious stimulus (hyperalgesia). The pain may also be spontaneous in the absence of any apparent peripheral stimulus. Oestrogens and prostaglandins probably play key modulatory roles in endometriosis and endometrialgia. Consequently many of the current medical treatments for the condition include oral drugs, like non-steroid anti-inflammatory drugs, contraceptives, progestogens, androgenic agents, gonadotrophin releasing hormone analogues, as well as laparoscopic surgical excision of the endometriosis lesions. However, management of pain in women with endometriosis is currently inadequate for many. Possibly acupuncture and cognitive therapy may be used as an adjunct.

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