PATHOPHYSIOLOGICAL APPROACHES TO TREATMENT OF PATIENTS WITH CHRONIC PALVIC PAIN AND PELVIC INFLAMMATORY DISEASES

Abstract

The article presents the pathophysiological features of the chronic pelvic pain (CPP) in women with pelvic inflammatory diseases. Multidisciplinary approaches to treatment, rehabilitation, drug therapy, physiotherapy and psychological rehabilitation are presented.Materials and methods. 90 women with pelvic inflammatory diseases were examined. The main group consisted of 50 women with CPP (I group) and 40 patients with painless course II group (comparison group). In assessing the pain syndrome, a visual analogue scale (VAS), a McGill pain questioner (MPQ), a Taylor scale, a Hamilton scale were used. The levels of luteotropic hormone (LH), follicle-stimulating hormone (FSH), estradiol, progesterone, prolactin, testosterone, DHEA- sulfate, and cytokines (IL-10, IL-6, TNF-α) were measured in serum.Results and discussion. The significantly increased level of proinflammatory cytokines IL-6, TNF-α in patients of the I group compared with II group (p <0,001), correlated with the duration of CPP, pelvic pain intensity VAS with a severe degree of depressive disorders, and a violation of hormone-endocrine ratios. The established pathophysiological disturbances were the basis for determining the therapeutic tactics of CPP by pelvic inflammatory diseases.Conclusions. The proposed therapeutic tactics contributed to the regression of the pain syndrome at 1, 3 and 6 months according to VAS 34,61%; 62,84% and 100%. The psychoemotional status improved by 88,3% of women, decrease in reactive anxiety and depressive disorders by 84,7% of patients, which indicates a high clinical effectiveness of the developed method of treatment.