Коли біль вводить в оману: діагностичні пастки при ендометріозі. Консиліум гінеколога, уролога, невролога
Бічна панель сторінки статті
Основний зміст сторінки статті
Анотація
Хронічний тазовий біль (ХТБ) у жінок є поширеною клінічною проблемою, яку часто неправомірно пов’язують виключно з ендометріозом. Такий редукціоністський підхід може призводити до діагностичних помилок, неефективного лікування та зниження якості життя хворих. Пацієнтки з ХТБ часто мають не лише гінекологічну патологію, а й ураження інших органів і систем організму, що характеризуються тривалим перебігом. Таким чином, медичний аспект проблеми часто поєднується з її соціальною значущістю та потребує комплексного підходу.
У статті здійснено огляд сучасних літературних джерел, розглянуто 5 клінічних випадків, які ілюструють альтернативні причини виникнення тазового болю. Наведено доказову базу щодо патогенезу сенситизації, ролі нейрозапалення та дисфункції тазового дна. Метою цього огляду є аналіз когнітивних помилок у клінічному мисленні лікарів, що призводять до надмірної діагностики ендометріозу при тазовому болю, а також опис інших можливих причин: нейропатичного болю, міофасціального синдрому, інтерстиціального циститу, центральної сенситизації.
Виявлено, що когнітивні упередження, як-от ефект звичного мислення та фокусування на одному діагнозі, перешкоджають адекватній діагностиці. Центральна сенситизація та крос-сенситизація часто пояснюють неефективність гормональної терапії. Опитувальник CSI-9, мануальне обстеження тазового дна та діагностика нейропатій є ключовими елементами правильного діагностичного алгоритму.
Комплексне ведення жінок із ХТБ потребує мультидисциплінарного підходу: залучення гінеколога, уролога, невролога, фізіотерапевта, психотерапевта дозволяє підвищити точність діагностики та ефективність лікування. Поєднання гормональної терапії з фізичним, психоемоційним і медикаментозним втручанням на рівні центральної нервової системи є оптимальним рішенням для більшості пацієнток із резистентним болем.
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Посилання
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