The World Health Organization defines quality of life as a person’s perception of his position in life in the context of the culture and value systems in which he lives, as well as in relation to his goals, expectations, standards and problems. Today, chronic pelvic pain is considered a condition that can significantly affect the quality of life. At the same time, there are significant prospects for using this method to evaluate the effectiveness of treatment. The objective: to evaluate of changes in the quality of life of patients with chronic pelvic pain syndrome (CPPS) depending on accompanying pathologies. Materials and methods. The examined cohort included 150 patients with CPPS, who according to the clinical manifestations were divided into groups A and B: group A (n=74) – patients with CPPS and suspicion for endometriosis and group B (n=76) – patients with CPPS and suspicion for combined benign proliferative diseases of reproductive organs. The control group included healthy women (n=50).SF-36 questionnaire which involves the use of eight scales of questions to determine the level of quality of life was used to assess the quality of life.Results. A decrease in quality of life was found in all the scales of the SF-36 questionnaire in patients with CPPS. A statistically significant difference was found in all scales between A and B groups compared to the control group (p<0.001).In addition, a significant difference was found in all scales of the questionnaire between the group with CPPS and combined benign proliferative diseases of the reproductive organs compared to the group with CPPS and endometriosis (p<0.05). At the same time, the most significant changes were found in the scale of physical role functioning and the scale of social role functioning.Conclusions. The decrease in indicators on all scales of the SF-36 questionnaire in patients of the studied cohort confirms that CPPS significantly affects all areas of their quality of life. Significantly lower indicators were observed in the group with CPPS and combined hyperproliferative pathology compared to the group with CPPS and endometriosis (p<0.05).

The objective: to study the significance of the levels of tumor necrosis factor α (TNF-α) and brain-derived neurotrophic factor (BDNF) in the blood of patients with chronic pelvic pain syndrome (CPPS).Materials and methods. The examined cohort included 150 patients with CPPS, who according to the clinical manifestations were divided into groups A and B: group A (n=74) included the patients with CPPS and suspicion of endometriosis and group B (n=76) – patients with CPPS and suspicion for benign proliferative diseases of reproductive organs. The control group included healthy women (n=50).Serum TNF-α and plasma BDNF levels were investigated by enzyme-linked immunosorbent assay. A visual analog scale (VAS) was used to study pain intensity.Results. The mean concentration of TNF-α in blood serum was significantly higher in women of group A (10.76±0.55 pg/ml) and group B (14.65±0.95 pg/ml) than in the control one (5.02±0.31 pg/ml). The mean concentration of BDNF in blood plasma was higher in women in group A (1473.88±53.02 pg/ml; p<0.001) and in group B (1711.65±66.79 pg/ml; p<0.01) compared to the control group (1082.91±56.24 pg/ml). The levels of TNF-α (p<0.001) and BDNF (p<0.01) are significantly higher in the blood of patients with CPPS and suspected combined benign proliferative diseases of the reproductive organs (group B) than in patients with CPPS and suspected endometriosis (group A).Between the intensity of pain according to VAS and the level of TNF-α in the blood a direct correlation of medium strength was found (r=0.56) in patients of group A and group B (r=0.62). A strong direct correlation between the intensity of pain according to VAS and the level of BDNF in the blood was established in women of group A (r=0.74) and group B (r=0.83).Between the disease duration and the level of TNF-α in the blood of patients a direct correlation of medium strength (r=0.65) in group A and a direct strong correlation (r=0.72) in group B were determined. Between the duration of the disease and the level of BDNF in the blood of patients a direct correlation of average strength was also establishe, a strong correlation (r=0.67) was determined in group A and a direct strong correlation (r=0.78) – group B.Conclusions. Women with CPPS and suspicion of benign proliferative diseases of the organs of the reproductive system have significantly higher concentrations of TNF-α and BDNF in the blood compared to healthy women (p<0.001).The existence of a direct correlation between the intensity of pain, the duration of the disease, and the levels of TNF-α and BDNF suggest the possibility of their use as objective markers of the effectiveness of diagnostic and therapeutic measures.

Львівський національний медичний університет імені Данила Галицького Зазвичай жінки, які страждають від хронічного тазового болю (ХТБ), відчувають його протягом певного часу і не звертаються по допомогу доти, поки біль не стане настільки сильним, що починає негативно впливати на нормальне щоденне функціонування, не дозволяючи жінці підтримувати звичайний спосіб життя, веде до розвитку хронічного больового синдрому. Синдром хронічного тазового болю часто супроводжується порушеннями поведінки, когнітивними, психоемоційними і сексуальними розладами, а також симптомами дисфункції нижніх відділів систем сечовиділення і травлення, органів тазового дна, гінекологічної дисфункції, які значною мірою є наслідком нейробіологічних, фізіологічних, а іноді й анатомічних змін в організмі та центральній нервовій системі. Розлади травної, урологічної та кістково-м'язової систем виявляють так само часто, як і розлади репродуктивної системи у жінок із ХТБ. Тому діагностичні заходи повинні бути спрямовані на виявлення усіх причин. У більшості випадків причини проблеми можуть бути встановлені під час ретельного збору анамнезу та фізикальному обстеженні, які повинні бути більш детальними, ніж зазвичай. Використання спеціально розроблених форм оцінювання та анкетування для пацієнтів з ХТБ може бути важливим і корисним для забезпечення охоплення всіх критичних моментів. Важливо враховувати ключову роль нервової системи у сприйнятті болю. Відчуття болю протягом тривалого часу може змінити те, як мозок сприймає та обробляє сигнали болю, що призводить до його посилення та міжорганної сенсибілізації. Складна диференційна діагностика часто обумовлює відсутність остаточного діагнозу у більшості пацієнток з ХТБ. Під час першого візиту хворої до лікаря іноді неможливо одразу визначити причину болю. Тому за наявності декількох етіопатогенетичних факторів лікування лише деяких з них може призвести до неповного полегшення. Під визначенням «хронічний тазовий біль» може ховатися багато захворювань, виявлення яких потребує залучення мультидисциплінарної команди за участю гінекологів, урологів, гастроентерологів, нефрологів, судинних хірургів, ортопедів, психіатрів, психологів та лікарів інших спеціальностей. Однак переважно саме гінекологи є спеціалістами, які першими контактують з даною патологією, позаяк у більшості випадків хворі на ХТБ насамперед звертаються по допомогу саме до них. Але лікарям часто не вистачає мультидисциплінарного підходу при менеджменті ХТБ, що, зі свого боку, ускладнює комплексне оцінювання, діагностику та лікування. Ключові слова: хронічний тазовий біль, міжорганна сенсибілізація, мультидисциплінарний підхід, синдром хронічного тазового болю. Chronic pelvic pain in women, stages and methods of diagnosis (Literature review) S.O. Shurpyak, O.b. Solomko Usually, women suffering from chronic pelvic pain experience it for some time and do not seek treatment until the pain becomes so severe that it adversely affects a woman's normal daily functioning, preventing her from maintaining a normal lifestyle and leading to development o...

Pain is an unpleasant sensory and emotional sensation associated with tissue damage or described in terms of such damage. Pain of different localization is one of the most common symptoms in modern clinical practice and one of the most common reasons for seeking medical care at the outpatient stage. One of the most promising and effective pathogenetic means of protection of peripheral pain receptors (nociceptors) are nonsteroidal anti-inflammatory drugs (NSAIDs). Every day, more than 30 million people in the world take NSAIDs, more than 300 million a year, and only a third of them take nonsteroidal anti-inflammatory drugs as prescribed by a doctor. However, patients taking various drugs today are considered as possible etiological and provoking factors in the development of a number of diseases of various organs and systems. All this determines the importance of selecting the optimal drug from the group of nonsteroidal anti-inflammatory drugs both from the standpoint of effectiveness and from the standpoint of safety in real clinical practice and including at the outpatient stage of providing medical care to the patient. One of the latest developments in this direction is dexibuprofen, the right-handed active isomer of ibuprofen, which according to numerous studies can be used as a symptomatic therapy of pain of mild to moderate intensity of various origins: toothache, back pain, joints, muscles, rheumatic pain, dysmenorrhea, and feel free to recommend it to a wide range of patients, as it has the optimal combination of efficacy and safety profile.

The objective: a study of the medical and social characteristics of women in reproductive age with chronic pelvic pain on the basis of retrospective analysis.Materials and methods. The analysis of medical documentation of 314 patients in reproductive age with a verified diagnosis of chronic pelvic pain (CPP) was performed on the basis of studying of case histories and outpatient cards. Data were analyzed: anthropometric data, age, body mass index, place of residence, gynecological pathology, duration and nature of the menstrual cycle, comorbidities, previous treatment, disease duration, pain intensity, bad habits, number of pregnancies and births, reproductive plans and other methods examination.Results. It was found that more than a third of women, who were treated for pathologies that cause CPP, need medical help again. 58 % of patients sought help for CPP for the first time, 42 % had already received treatment for CPP. Concomitant non-gynecological pathology is more often observed in such patients (48.7 %).The most commonly diagnosed were interstitial cystitis (42 %) and irritable bowel syndrome (34 %). The combination of gynecological, urological and surgical pathology was found in 22 % of patients. Patients with CPP had deficiency in vitamin D (68 % of the 162 patients tested for vitamin D) and had subjectively more severe pain. At the same time, the lack of routine examination of thyroid function and vitamin D status attracted attention. Simultaneously, women with CPP are much more likely than the general population to have infertility (56.4 %), and the incidence of miscarriage is twice as high as the population, with a tendency to recurrent pregnancy loss.Conclusions. Concomitant non-gynecological pathology, infertility, miscarriage, vitamin D deficiency and subjectively more severe pain are more common in women with chronic pelvic pain. However, the level of diagnosing thyroid pathology and determining the concentration of vitamin D in such patients is insufficient.