Psychosomatische Aspekte chronischer Unterbauchschmerzen der Frau

Subscribe to RSS DOI: 10.1055/s-2005-873080 Georg Thieme Verlag KG Stuttgart · New York Psychosomatische Aspekte chronischer Unterbauchschmerzen der Frau Psychosomatic Aspects of Chronic Pelvic Pain in WomanPublication History Eingang Manuskript: 11.8.2005 Eingang revidiertes Manuskript: 15.11.2005 Akzeptiert: 21.11.2005 Publication Date: 11 May 2006 (online) Abstract Chronic pelvic pain is a clinically significant condition in gynecology due to the frequency with which it occurs but also because of the stress it causes for patients. This complex clinical presentation has different definitions in the literature but based on its symptoms, it is usually classified as belonging to the somatic pain disorders. It has a significant co-morbidity with other disorders, including menstrual disorders such as dysmenorrhea and certain rare bleeding disorders, excretory problems such as urinary urge incontinence and obstipation as well as a high number of sexual disorders and other genital disorders such as pruritus. This complexity requires an interdisciplinary approach, in which discussions addressing possible psychosomatic origins play a role in addition to medication or invasive procedures such as diagnostic and operative laparoscopy or hysterectomy procedures. For chronic manifestations of pelvic pain the multidisciplinary approach should also include treatment options such as balneotherapy, psychotherapy and systemic therapy. These options can include relaxation techniques and training on how to cope with pain. Psychosomatic primary care is particularly important, as often it is necessary to help the patient develop the motivation and willingness to attempt psychotherapy, i.e. to develop the required introspection and preparedness to acknowledge the possible psychological origin of the pain. In cases of chronic pain in-patient psychological care should also be available, as this setting offers the best combination of physical and psychotherapeutic treatment. A biopsychosocial clinical picture is necessary for the diagnosis and the therapy of chronic pelvic pain to ensure that the therapeutic concept will take account of somatic causes together with physical co-morbidities and social influences. Key words Chronic pelvic pain - psychosomatic - psychotherapy - biopsychosocial disease model Literatur - 1 Artner J. Funktionelle Unterleibsschmerzen der Frau. Med Klinik. 1982; 77 683 - 2 Beutel M E, Weidner K, Brähler E. Der chronische Unterbauchschmerz der Frau und seine Komorbidität. Geburtsh Frauenheilk. 2005; 65 61-67 - 33 Bodden-Heidrich R. Chronische Unterbauchschmerzen „chronic pelvic pain syndrome“. Ein multifaktorelles Krankheitsbild mit Indikation zur interdisziplinären Behandlung. Gynäkologe. 2001; 34 299-306 - 3 DGPFG-Leitlinie 2004. Deutsche Gesellschaft für Psychosomatische Frauenheilkunde und Geburtshilfe e. V., Leitlinie, letzte Aktualisierung 11/2004. Homepage: www.uni-duesseldorf.de WWW/AWMF/11/016-001.htm . 2004 - 4 Fry R PW, Crisp A H, Beard R W. Sociopsychological factors in chronic pelvic pain: a review. J Psychosom Res. 1997; 42 1-15 - 5 Gelbaya T A, El-Halwagy H E. Focus on primary care: chronic pelvic pain in women. Obstet Gynecol Surv. 2001; 56 757-764 - 6 Guay D RP. Adjunctive agents in the management of chronic pain. Pharmacother. 2001; 21 1070-1081 - 7 Gürel S A, Gürel H. The effect of grandmultiparity on chronic pelvic pain and sexual discomfort. Int J Gynecol Obstet. 1997; 57 133-138 - 8 Gunter J. Chronic pelvic pain: an integrated approach to diagnosis and treatment. Obstet Gynecol Surv. 2003; 58 615-623 - 9 Howard F M, El Minawi A M, Sanchez R A. Conscious pain mapping by laparoscopy in women with chronic pelvic pain. Obstet Gynecol. 2000; 96 934-939 - 10 Jamieson D J, Steege J F. The prevalence of dysmenorrhea, dyspareunia, pelvic pain and irritable bowl syndrom in primary care practices. Obstet Gynecol. 1996; 1 55-59 - 11 Kapfhammer H P. Somatoforme Störungen - Historische Entwicklung und moderne diagnostische Konzeptualisierung. Nervenarzt. 2001; 72 487-500 - 12 Lampe A, Solder E, Ennemoser A, Schubert C, Rumpold G, Sollner W. Chronic pelvic pain and previous sexual abuse. Obstet Gynecol. 2000; 96 929-933 - 13 McGowan L, Clark-Carter D D, Pitz M. Chronic Pelvic Pain: a meta-analytic review. Psychology Health. 1998; 13 937-951 - 14 Mathias S D, Kuppermann M, Liberman R F, Lipschutz R C, Steege J F. Chronic pelvic pain: prevalence, health related quality of life and economic correlates. Obstet Gynaecol. 1996; 87 321-327 - 15 Milburn A, Reiter R C, Rhomberg A T. Multidisciplinary approach to chronic pelvic pain. Obstet Gynecol Clin North Am. 1993; 20 643-661 - 16 Molinski H. Unterleibsschmerz ohne Organbefund und eine Bemerkung zum pseudo-infektuösen Syndrom der Scheide. Gynäkologe. 1982; 15 207-215 - 17 Moore J, Kennedy S. Causes of chronic pelvic pain. Baillieres Best Pract Res Clin Obstet Gynaecol. 2000; 14 389-402 - 18 Neises M, Ploeger A. Arzt/Ärztin-Patientin-Beziehung. Gynäkologe. 2003; 36 1046-1051 - 19 Neises M. Psychotherapie in der Gynäkologie - Problemstellungen bei der Psychotherapie in der Frauenheilkunde. Faller H Psychotherapie bei somatischen Erkrankungen. Krankheitsmodelle und Therapiepraxis - störungsspezifisch und schulenübergreifend. Stuttgart; Thieme 2005: 128-143 - 20 Nijs P. Therapie als Begegnungskunst. Leuven; Peeters 2002: 403-433 - 21 Prill H J. Psychosomatische Gynäkologie. München; Urban & Schwarzenberg 1964 - 22 Reiter R C. Chronic pelvic pain. Klin Obstet Gynecol. 1990; 33 117-118 - 23 Reiter R C, Gambone J C. Demographic and historic variables in women with idiopathic chronic pelvic pain. Obstet Gynecol. 1990; 75 428-432 - 24 Richter D. Unterbauchschmerz. Stauber M, Kentenich H, Richter D Psychosomatische Geburtshilfe und Gynäkologie. Berlin; Springer 1999: 511-521 - 25 Richter D. Psychosomatische Therapie chronischer Unterbauchschmerzen. Richter D, Schuth W, Müller K. Psychosomatische Gynäkologie und Geburtshilfe. Gießen; Psychosozial 1998: 117-126 - 26 Savidge C J, Slade P. Psychological aspects of chronic pelvic pain. J Psychosom Res. 1997; 42 433-444 - 27 Scialli A R. Evaluating chronic pelvic pain. A Consensus recommendation. Pelvic Pain Expert Working Group. J Reprod Med. 1999; 44 945-952 - 28 Shorter E. Moderne Leiden. Zur Geschichte der psychosomatischen Krankheiten. Reinbek; Rowohlt 1994 - 29 Siedentopf F, Kentenich H. Zum chronischen Unterbauchschmerz der Frau. Zentralbl Gynäkol. 2004; 126 61-66 - 30 Sutton C J, Pooley A S, Ewen S P, Haines P. Follow-up report on a randomized controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal to moderate endometriosis. Fertil Steril. 1997; 68 1070-1074 - 34 Taylor H O. Pelvic pain based on a vascular and autonomic nervous system disorder. Am J Obstet Gynecol. 1954; 67 1177-1196 - 31 The American College of Obstetricans and Gynecologists .Clinical updates in Women's health care, somatization disorders. http://www.clinicalupdates.org 2004 3 (Nr. 4, July) - 32 Zondervan K T, Yudkin P L, Vessey M P, Jenkinson C P, Dawes M G, Barlow D H, Kennedy S H. Chronic pelvic pain in the community - symptoms, investigations and diagnoses. Am J Obstet Gynecol. 2001; 184 1149-1155 Prof. Dr. M. Neises Funktionsbereich Psychosomatische Frauenheilkunde der Medizinischen Hochschule Hannover Carl-Neuberg-Straße 1 30655 Hannover Email: [email protected]