发展中的慢性盆腔疼痛的进化思考

发展中的慢性盆腔疼痛的进化思考
Evolutionary considerations in the development of chronic pelvic pain

Abstract
Chronic pelvic pain is common among women of reproductive age and is associated with significant morbidity and comorbidities. In this Viewpoint, we explore the evolutionary cause of pelvic pain and summarize evidence that supports a menstruation-related evolutionary cause of chronic visceral pelvic pain: (1) lifetime menstruation has increased; (2) severe dysmenorrhea is common in the chronic pelvic pain population, particularly among those with pain sensitization; and (3) a potential biological mechanism can be identified. Thus, chronic pelvic pain may arise from the mismatch between the slow pace of biological evolution in our bodies and the relatively rapid pace of cultural changes that have resulted in increased menstrual frequency due to earlier menarche, later mortality, and lower fecundity. One possible mechanism that explains the development of persistent pain from repeated episodes of intermittent pain is hyperalgesic priming, a physiological process defined as a long-lasting latent hyperresponsiveness of nociceptors to inflammatory mediators after an inflammatory or neuropathic insult. The repetitive severely painful menstrual episodes may play such a role. From an evolutionary perspective the relatively rapid increase in lifetime menstruation experience in contemporary society may contribute to a mismatch between lifetime menstruation and the physiological pain processes, leading to a maladaptive state of chronic visceral pelvic pain. Our current physiology does not conform to current human needs.
摘要
慢性盆腔疼痛是常见的育龄妇女，与显著的发病率和并发症相关。从这个角度看，我们探讨盆腔疼痛的原因并总结进化支持慢性内脏盆腔疼痛的月经相关的进化原因的证据：（1）终身月经增多了；（2）严重的痛经在慢性盆腔疼痛人群中常见，特别是在那些疼痛敏化；和（3）的一个潜在的生物机制可以识别。因此，慢性盆腔疼痛可能来自我们身体的生物进化速度缓慢之间，已导致增加的频率由于月经初潮提前，晚期死亡文化变迁的速度比较快的不匹配，以及较低的繁殖力。一个可能的机制来解释的持续性疼痛的发展，反复发作的间歇性疼痛是痛觉过敏引发，一个生理过程定义为一种持久的潜在的气道高反应性作用的炎症介质的炎症或神经损伤后。重复性严重的痛苦的月经期可能会起到这样的作用。从进化的角度来看，在当代社会中终身月经经验相对快速的增加可能有助于月经生理疼痛过程和寿命之间的不匹配，导致一种不良的慢性盆腔疼痛的状态。我们目前的生理学不符合当前的人类需求。

KEYWORDS:
chronic pelvic pain; dysmenorrhea; evolutionary cause; evolutionary medicine; hyperalgesic priming; pain sensitization; pain testing; proximal cause
关键词：
慢性盆腔痛；痛经；进化的原因；进化医学；痛觉过敏引发；疼痛敏化；疼痛测试；近的原因

原文：
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发展中的慢性盆腔疼痛的进化思考