DYSMENORRHEA INDUCED BY LUMBOSACRAL SPINE DISORDERS. PATHOGENESIS, DIAGNOSIS AND THERAPY WITH SPECIAL EMPHASIS ON SPINAL MANIPULATIVE THERAPY
Autori:
Vjekoslav Grgić
Sažetak
Sažetak. Dismenoreja (bolne menstruacije), koja može biti primarna ili sekundarna, čest je ginekološki problem. Primarna dismenoreja (normalan ginekološki nalaz) uzrokovana je povećanom proizvodnjom prostaglandina u maternici. Naime, pod utjecajem hormonskih promjena i vegetativnih čimbenika pri kraju menstruacijskog ciklusa, u brojnih djevojaka i žena s normalnim ginekološkim nalazom nastaje vazokonstrikcija malih arterija maternice i ishemija endometrija, što rezultira prekomjernom sintezom prostaglandina u endometrijskim stanicama. Lokalno djelovanje prostaglandina na maternicu manifestira se bolnim kontrakcijama miometrija tijekom menstruacije. Prostaglandini mogu izazvati i opće simptome (glavobolja, mučnina, povraćanje, proljev, učestalo mokrenje) budući da se oslobađaju iz stanica endometrija i dospijevaju u ¬sistemsku cirkulaciju (povećane razine prostaglandina u plazmi, osobito prostaglandina F2alpha). Nesteroidni protuupalni lijekovi prihvaćeni su kao početna terapija u žena s primarnom dismenorejom, potom dolaze u obzir oralni kontraceptivi, kao i drugi preskripcijski lijekovi te različiti oblici komplementarne terapije. U 20–25% slučajeva ne postiže se smanjenje boli primjenom standardne terapije. Klinička su iskustva pokazala da se primjenom spinalne manipulativne terapije (SMT), koja je indicirana u žena s primarnom dismenorejom u kojih istodobno postoje funkcionalni poremećaji lumbosakralne (LS) kralježnice, često postiže značajna regresija boli tijekom menstruacijskog ciklusa. Naime, aktivacijom nocicepcijskog i vegetativnog sustava, poremećaji LS kralježnice, prije svega segmentalna disfunkcija i degenerativne promjene, mogu izazvati prenesenu bol i refleksne smetnje u zdjeličnim organima (somatovisceralni refleksi). Budući da se adekvatnom terapijom koegzistirajućih vertebralnih poremećaja u žena s primarnom dismenorejom često postiže značajno poboljšanje ili nestanak boli tijekom menstruacijskog ciklusa, kliničkim pregledom važno je prepoznati latentne ili manifestne vertebralne poremećaje u dismenorejičnih žena.
Summary
Summary. Dysmenorrhea (painful menstruation), which can be primary or secondary, is a common gynecological problem. Primary dysmenorrhea (normal gynecological finding) is caused by increased production of uterine prostaglandins. Namely, under the influence of hormonal changes and vegetative factors at the end of a menstrual cycle, in numerous girls and women with a normal gynecological finding, vasoconstriction in small uterine arteries and endometrial ischemia occur, resulting in excessive prostaglandins synthesis in endometrial cells. Local effect of prostaglandins on the uterus is manifested by painful uterine contractions during menstruation. Prostaglandins can cause general symptoms too (headache, nausea, vomiting, diarrhea, urinary frequency) because they are released from endometrial cells and they reach the systemic circulation (increased plasma levels of prostaglandins, particularly F2alpha prostaglandin). Nonsteroidal anti-inflammatory drugs are established as initial therapy for women with primary dysmenorrhea; besides that, oral contraceptives and other prescription drugs are taken into consideration as well as different forms of complementary therapy. In 20–25% of cases, the reduction of pain is not achieved by use of standard therapy. Clinical experiences have shown that significant pain regression during a menstrual cycle has been often achieved by the use of spinal manipulative therapy (SMT) indicated in women with primary dysmenorrhea with coexisting functional disorders of lumbosacral (LS) spine. Namely, by activation of the nociceptive and vegetative system, LS spine disorders, before all segmental dysfunction and degenerative changes, can induce referred pain and reflex disturbances of pelvic organs (somatovisceral reflexes). Since significant improvement or disappearance of pain during a menstrual cycle is often achieved with adequate therapy of coexisting vertebral disorders in women with primary dysmenorrhea, it is important to recognise latent or manifest vertebral disorders in dysmenorrheic women using clinical examination.
