Features of the vegetative status and quality of life in patients with external genital endometriosis and chronic pelvic pain syndrome

Abstract

Hypothesis/aims of study. 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. Study design, materials, and methods. 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). Results. 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 (p < 0.05). In addition, women with EGE and CPPS have significantly reduced quality of life compared to patients with EGE and without CPPS. Conclusion. 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.