{"paper_id":"99a6602a-1593-4211-a6db-d5648458b6fc","body_text":"Zusammenfassung\nHintergrund\nDie 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, eine Ausstrahlung der Schmerzen, unspezifische Blasen- und Darmbeschwerden oder auch Depressionen auf. Im Rahmen der diffusen Beschwerdeproblematik werden oft nicht nur Gynäkolog*innen von den betroffenen Patientinnen konsultiert, sondern auch Kolleg*innen anderer Disziplinen (Innere Medizin, Gastroenterologie, Orthopädie, Schmerztherapie, Psychologie etc.).\nFragestellung\nDie Komplexität der Erkrankung Endometriose wird dargestellt. Die sich daraus ergebenden Ansätze zur multimodalen, interdisziplinären, ganzheitlichen Therapie werden beschrieben.\nErgebnisse\nNeben hormonellen und operativen Therapien, die meist in gynäkologischer Hand liegen, sollten interdisziplinär eine optimale schmerztherapeutische Begleitung, Ernährungsberatung, psychologische Begleitung und physiotherapeutische Behandlung ins Behandlungskonzept aufgenommen werden. Der vorliegende Beitrag soll einen Überblick über mögliche Behandlungsstrategien bei chronisch symptomatischer Endometriose geben.\nSchlussfolgerung\nMithilfe einer multimodalen Therapie unter Berücksichtigung der komplexen pathophysiologischen Veränderungen können die komplexen Beschwerden, die die Lebensqualität signifikant einschränken, deutlich verbessert werden.\nAbstract\nBackground\nThe pain phenomena caused by endometriosis are manifold. In addition to nociceptive pain there is also a nociplastic reaction with central sensitization. Atypical symptoms, such as acyclic lower abdominal pain, radiating pain, nonspecific bladder and intestinal complaints or even depression increasingly occur in addition to the classical cyclic complaints, such as severe dysmenorrhea, cyclic lower abdominal pain, dyspareunia, dysuria and dyschezia. Due to the diffuse range of symptoms, affected patients often consult not just gynecologists but also specialists from other disciplines (internal medicine, gastroenterology, orthopedics, pain therapy, psychology etc.).\nObjective\nThe complexity of endometriosis is presented. The resulting approaches to multimodal interdisciplinary holistic treatment are described.\nResults\nInterdisciplinary concepts should be involved in the optimal treatment of endometriosis patients along with hormonal and surgical treatment, mostly under the supervision of a gynecologist and pain management, dietary changes, psychological support and physiotherapeutic management should also be included. 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Fortbildungsorganisationen Das FORTBILDUNGSKOLLEG GmbH, Jenapharm, Gedeon Richter, Johnson & Johnson, Stiftung Endometriose-Forschung, Arbeitsgemeinschaft Endometriose (AGEM), NORSAN und Organon gehalten zu haben.\nFür diesen Beitrag wurden von der Autorin keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.\nAdditional information\nEinige Abschnitte dieses Beitrags basieren auf dem Beitrag Endometrioseschmerz beherrschen derselben Autorin [42].\nQR-Code scannen & Beitrag online lesen\nRights and permissions\nAbout this article\nCite this article\nMechsner, S. Ganzheitliche Behandlung der Endometriose. Schmerz 37, 437–447 (2023). https://doi.org/10.1007/s00482-023-00747-0\nReceived:\nRevised:\nAccepted:\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s00482-023-00747-0\nSchlüsselwörter\n- Nozizeptiver Schmerz\n- Noziplastischer Schmerz\n- Zentrale Sensitivierung\n- Chronischer Schmerz\n- Multimodale Therapie","source_license":"CC0","license_restricted":false}