RESUMO
The case of a 39 year old woman who had diastasis of pubic symphysis following childbirth and later developed severe chronic neuropathic pain and disability is presented. She received extensive surgical and medical treatment for 6 years with no improvement of symptoms. The VNRS (Visual Numerical Rating Scale) pain score was 7/10 or more most of the time. This was quite disabling in terms of her quality of life. A spinal cord stimulator was inserted after failure of other modalities of pain management which resulted in dramatic improvement in the quality of life measured with SF-36 questionnaire. Her pain score became 0/10 VNRS and she was free from opioids and psychotropic medications within 3 months post insertion. Spinal cord stimulator can be considered for the management of pain due to diastasis of pubic symphysis, not amenable to other therapies.
Assuntos
Dor Crônica/terapia , Terapia por Estimulação Elétrica , Complicações do Trabalho de Parto/diagnóstico , Diástase da Sínfise Pubiana/terapia , Medula Espinal , Adulto , Dor Crônica/complicações , Eletrodos Implantados , Feminino , Humanos , Complicações do Trabalho de Parto/diagnóstico por imagem , Complicações do Trabalho de Parto/terapia , Manejo da Dor , Parto , Gravidez , Sínfise Pubiana/diagnóstico por imagem , Sínfise Pubiana/lesões , Diástase da Sínfise Pubiana/diagnóstico por imagem , Diástase da Sínfise Pubiana/etiologia , Radiografia , Resultado do Tratamento , UltrassonografiaRESUMO
La diástasis de la sínfisis púbica en la mujer embarazada es una entidad frecuente e infravalorada, que se relaciona con importante repercusión sobre la morbilidad maternal y con alta prevalencia de dolor crónico pélvico en las mujeres. La impotencia funcional que llega a ocasionar y el importante dolor con el que se relaciona, implica la utilización de un grupo de alternativas terapéuticas, que van desde el reposo en cama, hasta una compleja corrección quirúrgica que refuerza la importancia y la necesidad de un correcto abordaje de la patología. Nuestro objetivo será, a partir de varios casos remitidos a la Unidad de Tratamiento del Dolor de nuestro centro, el realizar una revisión de esta patología, con una aproximación a las pacientes, revisando las alternativas terapéuticas con las que contamos para este tipo de cuadros y su repercusión sobre la calidad de vida del binomio materno-fetal y cronificación del dolor (AU)
Pubic symphysis diastasis in pregnancy is a frequent and underestimated problem that has important repercussions on maternal morbidity and high prevalence of chronic pelvic pain in women. The functional impotence that it causes and the associated severe pain, entails the use of a number of therapeutic alternatives, ranging from bed rest to complex corrective surgery, reinforcing the importance and necessity of a correct approach to this pathology. Our aim is, after studying many cases referred to the Pain Treatment Unit at our centre, to carry out a review of this pathology, contacting patients, reviewing the therapeutic alternatives available for these types of conditions and their repercussions on the quality of life of the maternal-foetal binomial and chronic pain (AU)