Chronic Pelvic Pain in Endometriosis: An Overview

Onofrio Triolo, Triolo, Antonio Simone Laganà, Emanuele Sturlese
Journal of clinical medicine research · 2013 · vol. 5(3) , pp. 153–63 · doi:10.4021/jocmr1288w · PMID:23671540 · W1969188916
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

Endometriosis, found in one-third of women with chronic pelvic pain, is associated with pain despite asymptomatic presentation in some cases and involves complex interactions between the nervous system and pelvic inflammation.

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This overview addresses chronic pelvic pain (CPP), focusing on endometriosis as one cause in women undergoing laparoscopy for CPP and noting that endometriosis is found in about one-third of such cases, while most women with histologically confirmed endometriosis are symptomatic. It describes how the variability in pain among patients may relate to factors such as disease stage (rASRM), implant size and extent, Douglas obliteration, and prior surgery, and it summarizes proposed mechanisms involving both central and peripheral nervous system interactions and pelvic inflammatory/proangiogenic cytokine changes that can alter pain pathways and innervation. The paper acknowledges that the etiology and treatment responses are not fully consistent and that there is a need for more efforts to develop non-invasive strategies for accurately diagnosing causes of endometriotic-related CPP. This paper is centrally about endometriosis — it is an overview linking endometriosis-related mechanisms to chronic pelvic pain.

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Abstract

Chronic pelvic pain (CPP) could be considered nowadays a deep health problem that challenges physicians all over the world. This because its aetiology is still unclear, the course of the disease could vary a lot among different patients and through time in the same patient, and the response to treatments is not every time successful. Among women who underwent laparoscopy for CPP, endometriosis is found in about 1/3 of the cases, while only 25% of women with histological confirmed endometriosis are asymptomatic. A wide range of variables may exert their influence on the resulting pain syndrome in endometriosis; for example, score according to American society for reproductive medicine (rASRM), size of the sub-peritoneal and pelvic wall implants, Douglas obliteration, previous surgery. It is widely accepted nowadays that central nervous system (CNS) and peripheral nervous system (PNS) seems to influence each other and this interconnection play a key role in pain modulation. Moreover, the phenomena induced by endometriosis in the pelvis, including the breakdown of peritoneal homeostasis and the induction of the production of proinflammatory and proangiogenic cytokines, are responsible of altered innervations and modulation of pain pathways in these patients. There are many proposed medical and surgical approach to treat this painful syndrome, although there is necessity of more efforts to create new non-invasive strategies that set a more accurate diagnosis of the causes of endometriotic-related CPP, and therefore facilitate its eradication.
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Chronic Pelvic Pain in Endometriosis: An Overview Abstract Chronic pelvic pain (CPP) could be considered nowadays a deep health problem that challenges physicians all over the world. This because its aetiology is still unclear, the course of the disease could vary a lot among different patients and through time in the same patient, and the response to treatments is not every time successful. Among women who underwent laparoscopy for CPP, endometriosis is found in about 1/3 of the cases, while only 25% of women with histological confirmed endometriosis are asymptomatic. A wide range of variables may exert their influence on the resulting pain syndrome in endometriosis; for example, score according to American society for reproductive medicine (rASRM), size of the sub-peritoneal and pelvic wall implants, Douglas obliteration, previous surgery. It is widely accepted nowadays that central nervous system (CNS) and peripheral nervous system (PNS) seems to influence each other and this interconnection play a key role in pain modulation. Moreover, the phenomena induced by endometriosis in the pelvis, including the breakdown of peritoneal homeostasis and the induction of the production of proinflammatory and proangiogenic cytokines, are responsible of altered innervations and modulation of pain pathways in these patients. There are many proposed medical and surgical approach to treat this painful syndrome, although there is necessity of more efforts to create new non-invasive strategies that set a more accurate diagnosis of the causes of endometriotic-related CPP, and therefore facilitate its eradication. doi: http://dx.doi.org/10.4021/jocmr1288w

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Outcome instruments

rASRM

Condition tags

endometriosischronic_pelvic_pain

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