标题：Pharmacological treatment and regional anesthesia techniques for pain management after completion of both conservative and surgical treatment of endometriosis and pelvic adhesions in women with chronic pelvic pain as a mandated treatment strategy
期刊名称：Annals of Agricultural and Environmental Medicine
印刷版ISSN：1232-1966
电子版ISSN：1898-2263
出版年度：2015
卷号：22
期号：2
页码：353-356
DOI：10.5604/12321966.1152094
出版社：Institute of Agricultural Medicine in Lublin
摘要：Introduction. Chronic pelvic pain syndrome occurs in 4–14% of women. Pain pathomechanism in this syndrome is complex,as it is common to observe the features of nociceptive, inflammatory, neuropathic and psychogenic pain. The commonfindings in women with pelvic pain are endometriosis and pelvic adhesions.Objective. Aim of the study was to test the effectiveness of pharmacological treatment and regional anesthesia techniquesfor pain control as the next step of treatment after the lack of clinical results of surgical and pharmacological methodsnormally used in the management of endometriosis and pelvic adhesions.Materials and method. 18 women were treated between January 2010 – October 2013 in the Pain Clinic of the Departmentof Anaesthesiology and Intensive Care at the Centre for Postgraduate Education in Warsaw due to chronic pelvic painsyndrome related to either endometriosis or pelvic adhesions. During the previous step of management, both conservativeand surgical treatments were completed without achieving satisfactory results. Initial constant pain severity was 3–9points on the Numeric Rating Scale, while the reported paroxysmal pain level was 7–10. The pharmacological treatmentimplemented was based on oral gabapentinoids and antidepressants, aided by neurolytic block of ganglion of Walther,pudendal nerve blocks and topical treatment (5% lidocaine, 10% amitriptyline, 10% gabapentin).Results. In 17 women, a significant reduction of both constant and paroxysmal pain was achieved, of which complete andpermanent cessation of pain occurred in 6 cases. One patient experienced no improvement in the severity of her symptoms.Conclusions. The combination of pain management with pharmacological treatment, pudendal nerve blocks, neurolysis ofganglion impar (Walther) and topical preparations in cases of chronic pelvic pain syndrome seems to be adequate medicalconduct after failed or otherwise ineffective causative therapy
