Pelvi-périnéologie

, Volume 3, Issue 3, pp 250–257

Traitement médicamenteux des névralgies pudendales

  • T. Riant
  • J. -J. Labat
  • A. Lassaux
  • R. Robert
  • M. Kalfahlah
  • M. Guérineau
Pratique Médicale / Medical Practice

Résumé

Les névralgies pudendales (NP) sont maintenant bien définies par des critères diagnostiques clairs. Leur traitement est avant tout chirurgical si elles sont rebelles aux infiltrations spécifiques. D’autres moyens sont disponibles et souvent indispensables: kinésithérapie, prise en charge globale, TENS, médicaments. La place des médicaments dans cette stratégie est souvent quasiment obligatoire, mal connue et rarement complètement efficace. Les médicaments sont, ici, une part du traitement et ne peuvent se concevoir que dans le cadre d’une stratégie prédéfinie. À l’image d’autres douleurs chroniques neuropathiques, les traitements médicamenteux que l’on peut proposer font principalement appel au tramadol, aux antidépresseurs et aux anti-épileptiques. La pauvreté en études cliniques randomisées spécifiques, les résultats thérapeutiques médicamenteux parfois insuffisants, pourvoyeurs d’effets secondaires non nuls, le caractère très invalidant de cette pathologie, «l’obligation» fréquente de prescrire hors AMM, rendent nécessaire une prise en charge transdisciplinaire effective.

Mots clés

Névralgie pudendale (NP) Anti-épileptiques Antidépresseurs Tramadol Douleurs chroniques Douleurs neuropathiques Douleurs périnéales Douleurs pelviennes chroniques 

Medical treatment of pudendal neuralgia

Abstract

Pudendal neuralgias are now well defined by clear diagnostic criteria. Their treatment is chiefly surgical if they do not succumb to local anesthesic blocks (infiltrations). Other means are available and often necessary: physiotherapy, a biopsychosocial approach, TENS, drugs. The place of drugs often seems practically obligatory, is poorly known and seldom totally successful. Drugs are only part of the treatment strategy in this pathology and can only be envisaged as part of a pre-defined therapeutic strategy. As with other kinds of neuropathic pain, the drug treatments which we can offer are in most cases tramadol, antidepressants and anticonvulsants. The paucity of randomized controlled trials in this field, the sometimes disappointing therapeutic results of using drugs and the non-negligeable side effects, the disabling effect of this pathology, all mean that an effective multidisciplinary approach is required.

Keywords

Pudendal neuralgia Perineal pain Complex chronic pelvic pain Neuropathic pain Tramadol Antidepressant Anticonvulsant 

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Copyright information

© Springer Paris 2008

Authors and Affiliations

  • T. Riant
    • 1
    • 2
  • J. -J. Labat
    • 2
  • A. Lassaux
    • 3
  • R. Robert
    • 2
    • 4
  • M. Kalfahlah
    • 2
    • 5
  • M. Guérineau
    • 2
    • 6
  1. 1.UETD M.-Bensignorcentre Catherine-de-SienneNantesFrance
  2. 2.Centre fédératif de pelvi-périnéologie, clinique d’urologieCHU de NantesNantes cedexFrance
  3. 3.UETDhôpital RothschildParis cedex 12France
  4. 4.Service de neurotraumatologieCHU de NantesNantes cedexFrance
  5. 5.Service de neurochirurgiehôpital de BayonneBayonneFrance
  6. 6.NantesFrance

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