【省立疼痛英语晨读】慢性盆腔会阴疼痛的中枢敏化的临床标准
英语晨读 ·
山东省立医院疼痛科英语晨读已经坚持10余年的时间了，每天交班前15分钟都会精选一篇英文文献进行阅读和翻译。一是可以保持工作后的英语阅读习惯，二是可以学习前沿的疼痛相关知识。我们会将晨读内容与大家分享，助力疼痛学习。
本次文献选自Levesque A, Riant T, Ploteau S, et al. Clinical Criteria of Central Sensitization in Chronic Pelvic and Perineal Pain (Convergences PP Criteria): Elaboration of a Clinical Evaluation Tool Based on Formal Expert Consensus[J]. Pain Medicine, 2018, 19(10): 2009–2015.
Abstract
Background. The evaluation of chronic pelvic andperineal pain (CPP) is often complex. The patient’sdescription of the pain often appears to be dispro-portionate to the limited findings on physical exami-nation and/or complementary investigations. Theconcept of central sensitization may allow better un-derstanding and management of patients with CPP.
Objective. The aim of this study was to elaborate aclinical evaluation tool designed to simply identifysensitization in pelvic pain.
Methods. A list of 63 items was submitted to 22 in-ternational CPP experts according to the Delphimethod.
摘要：
背景 慢性盆腔会阴疼痛(CPP)的评估通常很复杂。病人描述的疼痛往往似乎与体格检查和辅助检查的有限发现并不相符。中枢敏化的概念可能能够更好地理解CPP患者及其治疗。
目标 本研究的目的是阐明一个临床评价工具的设计，以简便地识别会阴痛中的中枢敏化。
方法 根据德尔福方法，63项列表分别提交给22个国际CPP专家。
（delphi法就是德尔菲法，也称专家调查法。1946年由美国兰德公司创始实行，其本质上是一种反馈匿名函询法，其大致流程是在对所要预测的问题征得专家的意见之后，进行整理、归纳、统计，再匿名反馈给各专家，再次征求意见，再集中，再反馈，直至得到一致的意见。该方法是由企业组成一个专门的预测机构，其中包括若干专家和企业预测组织者，按照规定的程序，背靠背地征询专家对未来市场的意见或者判断，然后进行预测的方法。）
Results. Ten clinical criteria were adopted for thecreation of a clinical evaluation tool: 1) pain influ-enced by bladder filling and/or urination, 2) paininfluenced by rectal distension and/or defecation,3) pain during sexual activity, 4) perineal and/or vul-var pain in response to normally nonpainful stimu-lation, 5) pelvic trigger points (e.g., in the piriformis,obturator internus, and/or levator ani muscles), 6)pain after urination, 7) pain after defecation, 8) painafter sexual activity, 9) variable (fluctuating) pain in-tensity and/or variable pain distribution, 10) mi-graine or tension headaches and/or fibromyalgiaand/or chronic fatigue syndrome and/or post-traumatic stress disorder and/or restless legs syn-drome and/or temporomandibular joint dysfunction and/or multiple chemical sensitivity.
Conclusions. This process resulted in the elabora-tion of a clinical evaluation tool designed to identifyand appropriately manage patients with CPP com-prising a sensitization component.
Key Words. Pelvic Pain; Sensitization; ChronicPain; Assessment
结果 临床评估工具采纳了10项临床标准:1)膀胱充盈和/或排尿影响疼痛；2)直肠膨胀和/或排便影响疼痛；3)性交痛；4)由非疼痛性刺激而产生的会阴和/或外阴部疼痛；5)盆腔触发点(例如,在梨状肌,闭孔内肌和/或提肛肌；6）排尿后疼痛；7）排便后疼痛；8）性行为后疼痛；9)疼痛强度和疼痛分布范围产生变化或波动；10)偏头痛或紧张性头痛和/或纤维肌痛和/或慢性疲劳综合症和/或创伤后应激障碍和/或不宁腿综合征和/或颞下颌关节功能障碍和/或多种药物过敏。
结论 这个过程产生了详细的临床评估工具，旨在识别并适当地治疗伴随敏化的CPP患者。
关键词：盆腔疼痛；敏化；慢性疼痛；评估