Journal of obstetrics and women's diseasesJournal of obstetrics and women's diseases1684-04611683-9366Eco-Vector1087610.17816/JOWD6845-12Research ArticleFeatures of the vegetative status and quality of life in patients with external genital endometriosis and chronic pelvic pain syndromeKuznetsovaDarya E.<p>MD, Post-Graduate Student, Assistant. The Department of Operative Gynecology, the Institute of Postgraduate Education</p>dashsemch@mail.ruhttps://orcid.org/0000-0001-7516-5203ProkopenkoSemyon V.<p>MD, PhD, DSci (Medicine), Professor, the Head of the Department of Nervous Diseases with a Course of Medical Rehabilitation of Postgraduate Education, the Medical Faculty</p>s.v.proc.58@mail.ruhttps://orcid.org/0000-0002-4778-2586MakarenkoTatyana A.<p>MD, PhD, DSci (Medicine), Associate Professor, the Head of the Department of Operative Gynecology, the Institute of Postgraduate Education</p>makarenko7777@yandex.ruhttps://orcid.org/0000-0001-7823-6222Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University051020196845121501201928032019Copyright © 2019, Kuznetsova D.E., Prokopenko S.V., Makarenko T.A.2019<p><strong><em>Hypothesis/aims of study.</em></strong> Chronic pelvic pain syndrome (CPPS) in patients with external genital endometriosis (EGE) has a mixed pathogenetic mechanism of formation, including nociceptive and neuropathic components. However, there is still no clear correlation between the severity of pain and the degree of EGE. Of particular importance in pain chronization is the imbalanced autonomic nervous system (ANS) forming complex psychosomatic status, which patients experience as stress. This condition reduces the quality of life and causes social disadaptation, which exacerbates the pathological picture of the disease and diminishes the effect of pathogenetic treatment of EGE. We aimed to investigate the features of the vegetative status and assess the quality of life in patients with EGE complicated by CPPS and with a painless course of the disease.</p>
<p><strong><em>Study design, materials, and methods.</em></strong> The study included 135 patients of reproductive age with grade III/IV EGE (r-AFS classification): 105 of them with CPPS and 30 without this syndrome. All these individuals underwent special ANS function testing and were assessed for the quality of life according to the Medical Outcomes Study Questionnaire Short Form 36 Health Survey (SF-36).</p>
<p><strong><em>Results.</em></strong> The features of the vegetative status in patients with EGE complicated by CPPS were identified, such as the predominance of the sympathicotonic type of vegetative reactivity, high scores of vegetative dysfunction syndrome (in groups of patients with CPPS in almost 100% of cases), as well as high levels of reactive and personal anxiety (<em>p</em> 0.05). In addition, women with EGE and CPPS have significantly reduced quality of life compared to patients with EGE and without CPPS.</p>
<p><strong><em>Conclusion.</em></strong> The presence of suprasegmental and segmental ANS disorders in women with EGE and CPPS partly explains the mechanisms of pain syndrome chronization. The identified features are likely to be the cause of ineffective relief of pain syndrome in the EGE pathogenetic treatment algorithms. The reduced quality of life of such patients dictates the need to develop an effective treatment regimen for EGE and CPPS. This therapy should include drugs of central action that stop the neuropathic component of the pain syndrome, which is based on the imbalance of ANS parameters.</p>external genital endometriosiscentral sensitization syndromechronic pelvic pain syndromeautonomic nervous systemautonomic dysfunctionquality of lifeнаружный генитальный эндометриозсиндром центральной сенситизациисиндром хронической тазовой боливегетативная нервная системавегетативная дисфункциякачество жизни[Оразов М.Р., Радзинский В.Е., Хамошина М.Б., и др. Эффективность лечения тазовой боли, обусловленной наружным генитальным эндометриозом // Трудный пациент. – 2017. – Т. 15. – № 8–9. – С. 24–27. [Orazov MR, Radzinskiy VE, Khamoshina MB, et al. Treatment efficacy in patients with pelvic pain caused by external genital endometriosis. Trudnyy patsient. 2017;15(8-9):24-27. (In Russ.)]][Manero MG, Alcazar JL. Interleukin-8 serum levels do not correlate with pelvic pain in patients with ovarian endometriomas. Fertil Steril. 2010;94(2):450-452. https://doi.org/10.1016/j.fertnstert.2009.03.074.][Chiantera V, Abesadze E, Mechsner S. How to understand the complexity of endometriosis-related pain. J Endometr Pelvic Pain Disord. 2018;9(1):30-38. https://doi.org/10.5301/je.5000271.][Chopin N, Ballester M, Borghese B, et al. Relation between severity of dysmenorrhea and endometrioma. Acta Obstet Gynecol Scand. 2006;85(11):1375-1380. https://doi.org/10.1080/00016340600935490.][Howard FM. Endometriosis and mechanisms of pelvic pain. J Minim Invasive Gynecol. 2009;16(5):540-550. https://doi.org/10.1016/j.jmig.2009.06.017.][Ефименко Т.О. Структура, характер и интенсивность болевого синдрома при различных формах наружного генитального эндометриоза // Журнал акушерства и женских болезней. – 2016. – Т. 65. – № 2. – C. 24–30. [Efimenko TO. The structure, nature and intensity of painin various forms of external genital endometriosis. Journal of obstetrics and womenʼs diseases. 2016;65(2):24-30. (In Russ.)]. https://doi.org/10.17816/JOWD65224-30.][Morotti M, Vincent K, Brawn J, et al. Peripheral changes in endometriosis-associated pain. Hum Reprod Update. 2014;20(5):717-736. https://doi.org/10.1093/humupd/dmu021.][Brawn J, Morotti M, Zondervan KT, et al. Central changes associated with chronic pelvic pain and endometriosis. Hum Reprod Update. 2014;20(5):737-747. https://doi.org/10.1093/humupd/dmu025.][Голубева В.Л. Вегетативные расстройства: клиника, лечение, диагностика: руководство для врачей. – М.: МИА, 2010. – 640 с. [Golubeva VL. Vegetativnye rasstroystva: klinika, lechenie, diagnostika: rukovodstvo dlya vrachey. Moscow: MIA; 2010. 640 p. (In Russ.)]][Labat JJ, Riant T, Delavierre D, et al. [Global approach to chronic pelvic and perineal pain: from the concept of organ pain to that of dysfunction of visceral pain regulation systems]. Prog Urol. 2010;20(12):1027-1034. https://doi.org/10.1016/j.purol.2010.08.056.][Богатова И.К., Семенова О.К. Состояние вегетативной нервной системы у женщин с генитальным эндометриозом // Вестник новых медицинских технологий. – 2007. – T. 14. – № 4. – C. 121–123. [Bogatova IK, Semenova OK. Psychological Features in Women with Genital Endometriosis. Journal of new medical technologies. 2007;14(4):121-123. (In Russ.)]][Сандакова Е.А., Чернышова И.В. Тревожно-депрессивные акцентуации в оценке качества жизни больных генитальным эндометриозом // Лечение и профилактика. – 2013. – № 2. – C. 54–58. [Sandakova EA, Chernyshova IV. The anxious depressive accentuations in assessment of quality of life of patients with genital endometriosis. Lechenie i profilaktika. 2013;(2):54-58. (In Russ.)]][Готье С.В., Константинов В.К. Методы оценки качества жизни прижизненных доноров органов // Вестник трансплантологии и искусственных органов. – 2017. – Т. 19. – № 1. – C. 82–88. [Got’e SV, Konstantinov VK. Assessment methods of quality of life of living organ donors. Russian Journal of Transplantology and Artificial Organs. 2017;19(1):82-88. (In Russ.)]. https://doi.org/10.15825/1995-1191-2017-1-82-88.][Федотова Л.В. Особенности вегетативного гомеостаза, функции эндотелия и качества жизни у женщин с эндометриозом: Автореф. дис. … канд. мед. наук. – Екатеринбург, 2012. [Fedotova LV. Osobennosti vegetativnogo gomeostaza, funktsii endoteliya i kachestva zhizni u zhenshchin s endometriozom. [dissertation] Ekaterinburg; 2012. (In Russ.)]]