Pain syndrome in adenomyosis. finding new pathogenesis links and non-hormonal correction opportunities. Literature review

Adenomyosis is characterized by polymorphism of clinical manifestations and is the cause of chronic pelvic pain associated with endometriosis in 53–80% of cases. Heavy dysmenorrhea in adenomyosis is a key factor that reduces the quality of life and, moreover chronic pain reduces stress resistance and launches the rehabilitation cytokines cascade, which causes exacerbation of endometriosis. Formation of painful syndrome with adenomyosis may be due to: changes in neurohumoral regulation, stimulation of nerves and blood vessels growth and myometrium inflammatory remodeling against the background of circulatory disorders and vascular sclerosis. These processes lead to violation of neuroimmune relationships that determine the increase in the number and sensitivity of nociceptors against the background of the chronic immuno-inflammatory process in endometrials and myometry.Experimental studies have shown that the supraspinal role of the nitric oxide (NO) is to indirect mechanical nociceptive reflexes. The dose-dependent L-arginine role in the pain syndrome formation also was shown; it was found that small doses of L-arginine lead to the activation of nNO-synthase and analgesic effect. Large doses are activated by cotorphine synthase to form a dipeptide of cortorphine (L-tyrosine-L-arginine), which induces the met-enkephalin release and analgesic effect. Individual studies have demonstrated a decrease in the symptoms of urinary pain syndrome during L-arginine treatment, which made it possible to include it into the European Association of Urologists recommendations on the chronic pelvic pain treatment in 2017.Clinical comparative study (2013) of the NO donator (L-arginine) effectiveness in the treatment of endometriosis-associated intermenstrual pelvic pain and dysmenorrhea showed a high efficiency of a 3-month course of combination therapy (dienogest 2 mg + Tivortin 4.2 g). Supplement of basic therapy by NO donator (L-аrginine) has shown a faster reaching the clinical effect on reducing endometriosis-associated symptoms and sustainable maintenance of the result achieved. The multifaceted pharmacological effects of L-arginine directly affect a number of essential factors for the adenomyosis development and progression, which allows using this drug in clinical practice.

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The state of prostate hemodynamics in patients with myophascial pain syndrome

Urologicheskie vedomosti ◽

10.17816/uroved7439-43 ◽

2017 ◽

Vol 7 (4) ◽

pp. 39-43 ◽

Cited By ~ 1

Author(s):

Valentin N Krupin ◽

Alexey V Krupin ◽

Anna N Belova ◽

Natalya A Nashivochnikova

Keyword(s):

Blood Flow ◽

Pelvic Pain ◽

Chronic Prostatitis ◽

Chronic Pelvic Pain ◽

Clinical Symptoms ◽

Clinical Manifestations ◽

Pain Syndrome ◽

The State ◽

Pain Symptoms ◽

Myofascial Syndrome

The aim of this study was to evaluate the state of blood flow in prostate in 59 men with chronic pelvic pain due to myofascial syndrome in the absence of clinical manifestations of chronic prostatitis and its dynamics against the background of the treatment. The results of the study revealed a reliable relationship between the severity of blood flow disorders in the prostate and the intensity of pain symptoms caused by myofascial syndrome. It was concluded that the hemodynamic disorders of the prostate caused by myofascial syndrome are important in the possible formation of clinical symptoms of chronic pelvic pain in men. (For citation: Krupin VN, Krupin AV, Belova AN, Nashivochnikova NA. The state of prostate hemodynamics in patients with myophascial pain syndrome. Urologicheskie vedomosti. 2017;7(4):39-43. doi: 10.17816/uroved7439-43).

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Experience of combined pudendal and sacral electrostimulation in a patient with chronic pelvic pain

Urologicheskie vedomosti ◽

10.17816/uroved9357-64 ◽

2019 ◽

Vol 9 (3) ◽

pp. 57-64

Author(s):

Andrey A. Polushkin ◽

Emil D. Isagulyan ◽

Aleksey A. Tomskiy ◽

Roman V. Salyukov

Keyword(s):

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Pain Treatment ◽

Pain Syndrome ◽

Pelvic Organ ◽

Modern Medicine ◽

First Year ◽

Long Time ◽

Self Service ◽

Stimulation Of

Treatment of patients with chronic pelvic pain is one of the most difficult tasks of modern medicine. Recently, surgical neuromodulation has been increasingly used to treat chronic pain syndrome. The positive experience of chronic sacral stimulation usage in patients with pelvic organ dysfunction accompanied by pain syndrome determines the appropriateness of further search for effective methods of chronic pelvic pain treatment, for example, its combination with stimulation of peripheral nerves. The article presents a clinical observation of a patient suffering from chronic pelvic pain for a long time, who underwent chronic electrical stimulation of the sacral roots in combination with sacral nerve stimulation. After the first year of treatment, a decrease in pain intensity on the visual analog scale from 8 to 3 points, depression on the Zips from 14 to 10 points and a decrease in the indicator on the anxiety scale from 14 to 11 points was observed. The patients quality of life was improved, pain attacks were decreased, daily motor activity was increased, self-service along with social communication indicators were improved and the need for medicines was decreased.

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