Treatment of chronic pelvic pain in patients with severe external genital endometriosis

Background. The issue of the treatment of patients with external genital endometriosis (EGE) accompanied by chronic pelvic pain (CPP) remains unresolved, and today the pathogenetic mechanisms of its formation remain unclear. The multifactorial components of the occurrence of pain in EGE dictate the need for combined treatment regimens aimed to stopping the various mechanisms of the formation of CPP syndrome. Objective. Assessment of the efficacy of complex therapy aimed to uncoupling the mechanisms of automation and chronization of pain in patients with EGE. Methods. The study included 105 women with EGE; using the method of mechanical randomization, they were divided into 2 groups and subgroups depending on the treatment regimen. The first (control) group included 30 patients who underwent conventional hormonal therapy of endometriosis with the dienogest. The second ones included 75 patients who underwent complex treatment using centrally acting agents (gabapentin or amitriptyline) or nimesulide in addition to the conventional hormonal therapy of endometriosis (dienogest), in order to uncoupling the mechanisms of automation and chronization of pain. Results. During the study, clinical efficacy of the combination treatment regimen was proved for patients with EGE and CPP syndrome; this regimen included gabapentin, amitriptyline and nimesulide in addition to hormone therapy with dienogest and led to the relief of chronic pelvic pain, normalization of autonomic dysfunction and improvement of the quality of life. Conclusion. In women with external genital endometriosis, the syndrome of chronic pelvic pain has a mixed pathogenetic mechanism of development attributable to local inflammation and the central sensitization. From the standpoint of the data obtained and the results of a clinical study, it is necessary to prescribe centrally acting drugs (gabapentin and amitriptyline) for the relief of pain, because they can suppress the inverted pain impulse and improve the parameters of autonomic homeostasis.

external genital endometriosis, chronic pelvic pain syndrome, neuropathic pain, nociceptive pain, autonomic dysfunction