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Endometrioseschmerz beherrschen

Stufenschema und klinische Erfahrungen

Management of endometriosis pain

Stage-based treatment strategies and clinical experience

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Zusammenfassung

Hintergrund

Die durch Endometriose bedingten Schmerzphänomene sind vielfältig. Neben nozizeptiven Schmerzen kommt es auch zu einer noziplastischen Reaktion mit zentraler Sensitivierung. Daher treten neben den klassischen zyklischen Beschwerden wie schwerer Dysmenorrhö, zyklischen Unterbauchschmerzen, Dyspareunie, Dysurie und Dyschezie auch zunehmend atypische Schmerzen wie azyklische Unterbauchschmerzen, Ausstrahlung der Schmerzen, unspezifische Blasen- und Darmbeschwerden oder Depressionen auf. Im Rahmen der diffusen Beschwerdeproblematik werden oftmals nicht nur Gynäkolog*innen von den betroffenen Patientinnen konsultiert, sondern auch Kolleg*innen anderer Disziplinen (unter anderem Innere Medizin, Gastroenterologie, Orthopädie, Schmerztherapie, Psychologie).

Fragestellung

Darstellung der schmerzpathophysiologischen Zusammenhänge und Komplexität der Erkrankung sowie sich darauf ergebender Ansätze zu multimodalen interdisziplinären Konzepten der ganzheitlichen Therapie von Endometriose.

Methode

Neben hormonellen und operativen Therapien, die meist in gynäkologischer Hand liegen, sollten interdisziplinär eine optimale schmerztherapeutische Begleitung, eine Ernährungsberatung, eine psychologische Begleitung sowie physiotherapeutische Behandlung in das Behandlungskonzept aufgenommen werden. Der vorliegende Beitrag soll einen Überblick über mögliche Behandlungsstrategien bei chronisch-symptomatischer Endometriose geben.

Schlussfolgerung

Mithilfe einer multimodalen Therapie unter Berücksichtigung der komplexen pathophysiologischen Veränderungen können die komplexen Beschwerden, die die Lebensqualität signifikant einschränken, deutlich verbessert werden.

Abstract

Background

Endometriosis is associated with various types of intense pain. In addition to nociceptive pain, there is also a nociplastic reaction with central sensitization. Atypical symptoms such as acyclic lower abdominal pain, radiating pain, non-specific bladder and intestinal complaints or even depression are frequent as are classic cyclical complaints such as severe dysmenorrhea, cyclical lower abdominal pain, dyspareunia, dysuria and dyschezia. In cases of a diverse range of symptoms, patients often consult not just gynecologists but specialists from other disciplines (e.g., internal medicine, gastroenterology, orthopedics, pain therapy, psychology).

Aims

Overview about the pathophysiology and complexity of the disease and the resulting treatment options. A multimodal interdisciplinary concept might be able to take into consideration all aspects of the complex disease.

Methods

Interdisciplinary concepts should be involved in the treatment of endometriosis patients along with hormonal and surgical therapy, which are generally under the supervision of a gynecologist. Pain management, dietary changes, psychological support, as well as physiotherapy should be included. The present article is intended to provide an overview of possible treatment strategies for chronic, symptomatic endometriosis.

Conclusion

The use of multimodal treatment strategies regarding the complex pathophysiological aspects of this disease might be helpful in significantly improving the quality of life of endometriosis patients.

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Authors and Affiliations

  1. Klinik für Gynäkologie, Endometriosezentrum Charité, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland

    Sylvia Mechsner

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Correspondence to Sylvia Mechsner.

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S. Mechsner gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von der Autorin keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Mechsner, S. Endometrioseschmerz beherrschen. Schmerz 35, 159–171 (2021). https://doi.org/10.1007/s00482-021-00543-8

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