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Chronic non-malignant pelvic-perineal pain: Management by anesthetic blocks. From theory to practice I: Philosophic and pathophysiologic approach


Pelviperineology 2014;33(4):103-109

The principles of treatment of chronic painful diseases have to be understood in the context of the sophisticated warning mechanisms that exist between the brain and peripheral tissue. Current pharmacological approach to pain control is essentially based on acute, nociceptive pain, whereas chronic non malignant pain is different, involving a restructuring of both peripheral and central neural networks, leading to wider cerebral integration and interpretation. New plans of treatment must be developed according to recent pathophysiological data on neuropathic pain, neuroinflammation, and neuroplasticity. Interpretation of physical phenomena occurring in human body derived from the mechanical philosophy of Descartes and linked with materialism and reductionism is today an anachronistic point of view. Data derived from fMRI (functional magnetic resonance imaging) suggest that mind and brain are indistinguishable from each other: behavioural influences, experience, motivation, exercise and drugs may modify neuronal circuits and determine a different response to similar inputs. On the other hand, repeated harmful afferent inputs may induce a chronic pathologic condition difficult to resolve by standard medical therapy: systemic opiates may only represent a way to relieve symptoms, but they are unable to offer a definitive resolution of the chronic painful state. Increased intraepithelial innervation by mast cells hyperactivation and microglia activation in nervous system lead to modifications of central circuits; these structural and functional variations may explain allodynia and hyperalgesia, and burning sensations as well. In vivo studies demonstrate morphological changes in the brain, as a consequence of pain perception, and that these may be reversible in nature if a correct treatment, based on these observations, is provided.

Keywords: Neuroinflammation; Chronic pelvic pain; Neuroplasticity.