Bringing Endometriosis to the Road of Contemporary Pain Science

Background Endometriosis pain is mainly understood based on peripheral lesion characteristics and an outdated perspective equating nociception with pain. This limited view may divert understanding of interventions beyond peripheral logic, leading clinicians to see approaches targeting other processes as supplementary, limiting the effective addressing of treatment failure. Integrating critical advancements in pain and endometriosis can promote more comprehensive knowledge.

This article provides a conceptual framework focusing on overlooked or less clearly linked areas concerning the interplay between nociception and factors influencing endometriosis pain. It explores the complexity of nociceptive processing, the association between neuromerically connected structures, and the role of the brain in pain perception. Further, it emphasizes adopting mechanism-based understanding of pain that integrates neurobiological aspects of the nociceptive apparatus and related systems, shaped by psychosocial factors contributing to a possible negative spiral in those living with endometriosis.

Aware of such a broader perspective can incentivize a balanced effort to inquire into peripheral lesion-related mechanisms and other domains potentially impacting endometriosis pain. Conflicts of Interest The authors declare no conflicts of interest. Data Availability Statement The authors have nothing to report.

- 1J. Vallvé-Juanico, S. Houshdaran, and L. C. Giudice, “The Endometrial Immune Environment of Women With Endometriosis,” Human Reproduction Update 25, no. 5 (2019): 564–591, https://doi.org/10.1093/humupd/dmz018. - 2S. A. Eucker, M. R. Knisely, and C. Simon, “Nonopioid Treatments for Chronic Pain—Integrating Multimodal Biopsychosocial Approaches to Pain Management,” JAMA Network Open 5, no. 6 (2022): e2216482. - 3S. As-Sanie, R. Black, L. C. Giudice, et al., “Assessing Research Gaps and Unmet Needs in Endometriosis,” American Journal of Obstetrics and Gynecology 221, no. 2 (2019): 86–94, https://doi.org/10.1016/j.ajog.2019.02.033. - 4E. Denny, “I Never Know From One Day to Another How I Will Feel: Pain and Uncertainty in Women With Endometriosis,” Qualitative Health Research 19, no. 7 (2009): 985–995, https://doi.org/10.1177/1049732309338725. - 5A. V. Apkarian and D. Reckziegel, “Peripheral and Central Viewpoints of Chronic Pain, and Translational Implications,” Neuroscience Letters 29, no. 702 (2019): 3–5, https://doi.org/10.1016/j.neulet.2018.11.040. 10.1016/j.neulet.2018.11.040Google Scholar - 6P. R. Koninckx, A. Ussia, R. Mashiach, G. Vilos, and D. C. Martin, “Endometriosis Can Cause Pain at a Distance,” Journal of Obstetrics and Gynaecology Canada 43, no. 9 (2021): 1035–1036, https://doi.org/10.1016/j.jogc.2021.06.002. - 7M. de França Moreira and M. A. P. Oliveira, “Endometriosis Pain or Its “Phantom” Pain? The Elephant in the Room of Research,” British Journal of Obstetrics and Gynaecology 132, no. 1 (2024): 15–17, https://doi.org/10.1111/1471-0528.17927. 10.1111/1471-0528.17927Google Scholar - 8C. M. Becker, A. Bokor, O. Heikinheimo, et al., “ESHRE Guideline: Endometriosis,” Hum Reprod Open 2022, no. 2 (2022): hoac009, https://doi.org/10.1093/hropen/hoac009. - 9L. Coxon, A. W. Horne, and K. Vincent, “Pathophysiology of Endometriosis-Associated Pain: A Review of Pelvic and Central Nervous System Mechanisms,” Best Practice & Research. Clinical Obstetrics & Gynaecology 51, no. 2 (2018): 53–67. - 10H. C. McNamara, H. C. Frawley, J. F. Donoghue, et al., “Peripheral, Central, and Cross Sensitization in Endometriosis-Associated Pain and Comorbid Pain Syndromes,” Frontiers in Reproductive Health 3 (2021): 729642. - 11S. Mechsner, “Endometriosis, an Ongoing Pain-Step-By-Step Treatment,” Journal of Clinical Medicine 11, no. 2 (2022): 467. - 12L. Coxon, L. Demetriou, and K. Vincent, “Current Developments in Endometriosis-Associated Pain,” Cell Reports Medicine 5, no. 10 (2024): 101769. - 13C. Agostinis, A. Balduit, A. Mangogna, et al., “Immunological Basis of the Endometriosis: The Complement System as a Potential Therapeutic Target,” Frontiers in Immunology 11 (2020): 599117, https://doi.org/10.3389/fimmu.2020.599117. - 14L. Schulke, M. Berbic, F. Manconi, N. Tokushige, R. Markham, and I. S. Fraser, “Dendritic Cell Populations in the Eutopic and Ectopic Endometrium of Women With Endometriosis,” Human Reproduction 24, no. 7 (2009): 1695–1703, https://doi.org/10.1093/humrep/dep071. - 15S. Vannuccini, S. Clemenza, M. Rossi, and F. Petraglia, “Hormonal Treatments for Endometriosis: The Endocrine Background,” Reviews in Endocrine & Metabolic Disorders 23, no. 3 (2022): 333–355, https://doi.org/10.1007/s11154-021-09666-w. - 16A. McCallion, Y. Nasirzadeh, H. Lingegowda, et al., “Estrogen Mediates Inflammatory Role of Mast Cells in Endometriosis Pathophysiology,” Frontiers in Immunology 9, no. 13 (2022): 961599, https://doi.org/10.3389/fimmu.2022.961599. 10.3389/fimmu.2022.961599Google Scholar - 17E. Greaves, K. Grieve, A. W. Horne, and P. T. K. Saunders, “Elevated Peritoneal Expression and Estrogen Regulation of Nociceptive Ion Channels in Endometriosis,” Journal of Clinical Endocrinology and Metabolism 99, no. 9 (2014): E1738–E1743, https://doi.org/10.1210/jc.2014-2282. - 18Y. Wei, Y. Liang, H. Lin, Y. Dai, and S. Yao, “Autonomic Nervous System and Inflammation Interaction in Endometriosis-Associated Pain,” Journal of Neuroinflammation 17, no. 1 (2020): 80, https://doi.org/10.1186/s12974-020-01752-1. - 19Z. Zhang, J. Wang, Y. Chen, et al., “Activin a Promotes Myofibroblast Differentiation of Endometrial Mesenchymal Stem Cells via STAT3-Dependent Smad/CTGF Pathway,” Cell Communication and Signaling 17, no. 1 (2019): 45, https://doi.org/10.1186/s12964-019-0361-3. - 20M. A. Giamberardino, R. Costantini, G. Affaitati, et al., “Viscero-Visceral Hyperalgesia: Characterization in Different Clinical Models,” Pain 151, no. 2 (2010): 307–322, https://doi.org/10.1016/j.pain.2010.06.023. - 21P. Berveiller, S. Ropert, and O. Mir, “Endometriosis,” New England Journal of Medicine 383, no. 2 (2020): 193–194, https://doi.org/10.1056/NEJMc2013221. - 22A. Y. Neziri, N. A. Bersinger, O. K. Andersen, L. Arendt-Nielsen, M. D. Mueller, and M. Curatolo, “Correlation Between Altered Central Pain Processing and Concentration of Peritoneal Fluid Inflammatory Cytokines in Endometriosis Patients With Chronic Pelvic Pain,” Regional Anesthesia and Pain Medicine 39, no. 3 (2014): 181–184, https://doi.org/10.1097/aap.0000000000000068. - 23B. Peng, H. Zhan, F. Alotaibi, G. M. Alkusayer, M. A. Bedaiwy, and P. J. Yong, “Nerve Growth Factor Is Associated With Sexual Pain in Women With Endometriosis,” Reproduction Science 25, no. 4 (2018): 540–549, https://doi.org/10.1177/1933719117716778. - 24P. Vercellini, L. Fedele, G. Aimi, G. Pietropaolo, D. Consonni, and P. G. Crosignani, “Association Between Endometriosis Stage, Lesion Type, Patient Characteristics and Severity of Pelvic Pain Symptoms: A Multivariate Analysis of Over 1000 Patients,” Human Reproduction 22, no. 1 (2007): 266–271, https://doi.org/10.1093/humrep/del339. - 25L. Demco, “Mapping the Source and Character of Pain due to Endometriosis by Patient-Assisted Laparoscopy,” Journal of the American Association of Gynecologic Laparoscopists 5, no. 3 (1998): 241–245, https://doi.org/10.1016/s1074-3804(98)80026-1. - 26P. R. Koninckx and M. Renaer, “Pain Sensitivity of and Pain Radiation From the Internal Female Genital Organs,” Human Reproduction 12, no. 8 (1997): 1785, https://doi.org/10.1093/humrep/12.8.1785. - 27A. L. Hsu, N. Sinaii, J. Segars, L. K. Nieman, and P. Stratton, “Relating Pelvic Pain Location to Surgical Findings of Endometriosis,” Obstetrics & Gynecology 118, no. 2 (2011): 223–230, https://doi.org/10.1097/AOG.0b013e318223fed0. - 28R. S. Roth, M. E. Geisser, and D. A. Williams, “Interventional Pain Medicine: Retreat From the Biopsychosocial Model of Pain,” Translational Behavioral Medicine 2, no. 1 (2012): 106–116, https://doi.org/10.1007/s13142-011-0090-7. - 29K. J. Berkley, A. Cason, H. Jacobs, H. Bradshaw, and E. Wood, “Vaginal Hyperalgesia in a Rat Model of Endometriosis,” Neuroscience Letters 306, no. 3 (2001): 185–188, https://doi.org/10.1016/s0304-3940(01)01906-1. - 30Z. Zhang, H. Zheng, Q. Yu, and X. Jing, “Understanding of Spinal Wide Dynamic Range Neurons and Their Modulation on Pathological Pain,” Journal of Pain Research 1, no. 17 (2024): 441–457, https://doi.org/10.2147/JPR.S446803. 10.2147/JPR.S446803Google Scholar - 31R. C. Coghill, “The Distributed Nociceptive System: A Framework for Understanding Pain,” Trends in Neurosciences 43, no. 10 (2020): 780–794, https://doi.org/10.1016/j.tins.2020.07.004. - 32A. Y. Neziri, S. Haesler, S. Petersen-Felix, et al., “Generalized Expansion of Nociceptive Reflex Receptive Fields in Chronic Pain Patients,” Pain 151, no. 3 (2010): 798–805, https://doi.org/10.1016/j.pain.2010.09.017. - 33F. Cervero, “Visceral Hyperalgesia Revisited,” Lancet 356, no. 9236 (2000): 1127–1128, https://doi.org/10.1016/S0140-6736(00)02750-1. - 34S. R. Till, A. Schrepf, D. J. Clauw, S. E. Harte, D. A. Williams, and S. As-Sanie, “Association Between Nociplastic Pain and Pain Severity and Impact in Women With Chronic Pelvic Pain,” Journal of Pain 24, no. 8 (2023): 1406–1414, https://doi.org/10.1016/j.jpain.2023.03.004. - 35G. Affaitati, R. Costantini, C. Tana, F. Cipollone, and M. A. Giamberardino, “Co-Occurrence of Pain Syndromes,” Journal of Neural Transmission 127, no. 4 (2020): 625–646, https://doi.org/10.1007/s00702-019-02107-8. - 36L. Grundy and S. M. Brierley, “Cross-Organ Sensitization Between the Colon and Bladder: To Pee or Not to Pee?,” American Journal of Physiology. Gastrointestinal and Liver Physiology 314, no. 3 (2018): G301, https://doi.org/10.1152/ajpgi.00272.2017. - 37A. Lara-Ramos, F. Álvarez-Salvago, C. Fernández-Lao, et al., “Widespread Pain Hypersensitivity and Lumbopelvic Impairments in Women Diagnosed With Endometriosis,” Pain Medicine 22, no. 9 (2021): 1970–1981, https://doi.org/10.1093/pm/pnaa463. - 38A. M. Cason, C. L. Samuelsen, and K. J. Berkley, “Estrous Changes in Vaginal Nociception in a Rat Model of Endometriosis,” Hormones and Behavior 44, no. 2 (2003): 123–131, https://doi.org/10.1016/s0018-506x(03)00121-1. - 39U. Wesselmann and J. Lai, “Mechanisms of Referred Visceral Pain: Uterine Inflammation in the Adult Virgin Rat Results in Neurogenic Plasma Extravasation in the Skin,” Pain 73, no. 3 (1997): 309–317, https://doi.org/10.1016/S0304-3959(97)00112-7. - 40C. M. Xia, M. A. Gulick, S. J. Yu, et al., “Up-Regulation of Brain-Derived Neurotrophic Factor in Primary Afferent Pathway Regulates Colon-To-Bladder Cross-Sensitization in Rat,” Journal of Neuroinflammation 9 (2012): 30, https://doi.org/10.1186/1742-2094-9-30. - 41N. Yoshimura, T. Oguchi, H. Yokoyama, et al., “Bladder Afferent Hyperexcitability in Bladder Pain Syndrome/Interstitial Cystitis,” International Journal of Urology 21 (2014): 18–25, https://doi.org/10.1111/iju.12308. - 42G. L. Moseley and D. S. Butler, “Fifteen Years of Explaining Pain: The Past, Present, and Future,” Journal of Pain 16, no. 9 (2015): 807–813, https://doi.org/10.1016/j.jpain.2015.05.005. - 43M. A. Fitzcharles, S. P. Cohen, D. J. Clauw, G. Littlejohn, C. Usui, and W. Häuser, “Nociplastic Pain: Towards an Understanding of Prevalent Pain Conditions,” Lancet 397, no. 10289 (2021): 2098–2110, https://doi.org/10.1016/S0140-6736(21)00392-5. - 44K. Vincent, C. Warnaby, C. J. Stagg, J. Moore, S. Kennedy, and I. Tracey, “Dysmenorrhoea Is Associated With Central Changes in Otherwise Healthy Women,” Pain 152, no. 9 (2011): 1966–1975, https://doi.org/10.1016/j.pain.2011.03.029. - 45M. Yano, A. Matsuda, T. Natsume, et al., “Pain-Related Behavior and Brain Activation in Cynomolgus Macaques With Naturally Occurring Endometriosis,” Human Reproduction 34, no. 3 (2019): 469–478, https://doi.org/10.1093/humrep/dey383. - 46S. As-Sanie, R. E. Harris, V. Napadow, et al., “Changes in Regional Gray Matter Volume in Women With Chronic Pelvic Pain: A Voxel-Based Morphometry Study,” Pain 153, no. 5 (2012): 1006–1014, https://doi.org/10.1016/j.pain.2012.01.032. - 47S. As-Sanie, J. Kim, T. Schmidt-Wilcke, et al., “Functional Connectivity Is Associated With Altered Brain Chemistry in Women With Endometriosis-Associated Chronic Pelvic Pain,” Journal of Pain 17, no. 1 (2016): 1–13, https://doi.org/10.1016/j.jpain.2015.09.008. - 48A. V. Apkarian, M. N. Baliki, and M. A. Farmer, “Predicting Transition to Chronic Pain,” Current Opinion in Neurology 26, no. 4 (2013): 360–367, https://doi.org/10.1097/WCO.0b013e32836336ad. - 49T. A. Toledo, B. L. Kuhn, M. F. Payne, et al., “The Effect of Pain Catastrophizing on Endogenous Inhibition of Pain and Spinal Nociception in Native Americans: Results From the Oklahoma Study of Native American Pain Risk,” Annals of Behavioral Medicine 54, no. 8 (2020): 575–594, https://doi.org/10.1093/abm/kaaa004. - 50T. Li, R. Mamillapalli, S. Ding, et al., “Endometriosis Alters Brain Electrophysiology, Gene Expression and Increases Pain Sensitization, Anxiety, and Depression in Female Mice,” Biology of Reproduction 99, no. 2 (2018): 349–359, https://doi.org/10.1093/biolre/ioy035. - 51M. N. Baliki and A. V. Apkarian, “Nociception, Pain, Negative Moods, and Behavior Selection,” Neuron 87, no. 3 (2015): 474–491, https://doi.org/10.1016/j.neuron.2015.06.005. - 52K. Bannister, J. Sachau, R. Baron, and A. H. Dickenson, “Neuropathic Pain: Mechanism-Based Therapeutics,” Annual Review of Pharmacology and Toxicology 60 (2020): 257–274, https://doi.org/10.1146/annurev-pharmtox-010818-021524. - 53E. Kosek, D. Clauw, J. Nijs, et al., “Chronic Nociplastic Pain Affecting the Musculoskeletal System: Clinical Criteria and Grading System,” Pain 162, no. 11 (2021): 2629–2634, https://doi.org/10.1097/j.pain.0000000000002324. - 54C. Colak, L. P. Chamie, J. Youngner, et al., “MRI Features of Pelvic Nerve Involvement in Endometriosis,” Radiographics 44, no. 1 (2024): e230106, https://doi.org/10.1148/rg.230106. - 55V. Anaf, C. Chapron, I. El Nakadi, V. De Moor, T. Simonart, and J. C. Noël, “Pain, Mast Cells, and Nerves in Peritoneal, Ovarian, and Deep Infiltrating Endometriosis,” Fertility and Sterility 86, no. 5 (2006): 1336–1343, https://doi.org/10.1016/j.fertnstert.2006.03.057. - 56L. Coxon, K. Wiech, and K. Vincent, “Is There a Neuropathic-Like Component to Endometriosis-Associated Pain? Results From a Large Cohort Questionnaire Study,” Frontiers in Pain Research 4, no. 2 (2021): 743812, https://doi.org/10.3389/fpain.2021.743812. 10.3389/fpain.2021.743812Google Scholar - 57L. Coxon, J. Vollert, D. Perro, et al., “Comprehensive Quantitative Sensory Testing Shows Altered Sensory Function in Women With Chronic Pelvic Pain: Results From the Translational Research in Pelvic Pain (TRiPP) Study,” Pain 164, no. 11 (2023): 2528–2539, https://doi.org/10.1097/j.pain.0000000000002955. - 58N. L. Orr, A. J. Huang, Y. D. Liu, et al., “Association of Central Sensitization Inventory Scores With Pain Outcomes After Endometriosis Surgery,” JAMA Network Open 6, no. 2 (2023): e230780, https://doi.org/10.1001/jamanetworkopen.2023.0780. - 59M. Possover, “Five-Year Follow-Up After Laparoscopic Large Nerve Resection for Deep Infiltrating Sciatic Nerve Endometriosis,” Journal of Minimally Invasive Gynecology 24, no. 5 (2017): 822–826, https://doi.org/10.1016/j.jmig.2017.02.027. - 60S. As-Sanie, S. R. Till, A. D. Schrepf, et al., “Incidence and Predictors of Persistent Pelvic Pain Following Hysterectomy in Women With Chronic Pelvic Pain,” American Journal of Obstetrics and Gynecology 225, no. 5 (2021): 568, https://doi.org/10.1016/j.ajog.2021.08.038. - 61V. Legrain, S. Van Damme, C. Eccleston, K. D. Davis, D. A. Seminowicz, and G. Crombez, “A Neurocognitive Model of Attention to Pain: Behavioral and Neuroimaging Evidence,” Pain 144, no. 3 (2009): 230–232, https://doi.org/10.1016/j.pain.2009.03.020. - 62G. Crombez, S. Van Damme, and C. Eccleston, “Hypervigilance to Pain: An Experimental and Clinical Analysis,” Pain 116, no. 1–2 (2005): 4–7, https://doi.org/10.1016/j.pain.2005.03.035. - 63J. Todd, B. Pickup, and D. Coutts-Bain, “Fear of Progression, Imagery, Interpretation Bias, and Their Relationship With Endometriosis Pain,” Pain 164, no. 12 (2023): 2839–2844, https://doi.org/10.1097/j.pain.0000000000003003. - 64M. F. Moreira and M. A. P. Oliveira, “Exploring the Interplay Between Catastrophizing and Endometriosis Pain Through Two-Wave and Intensive Longitudinal Data,” Pain Medicine 3 (2024): pnae132, https://doi.org/10.1093/pm/pnae132. 10.1093/pm/pnae132Google Scholar - 65M. F. Moreira, O. L. Gamboa, and M. A. P. Oliveira, “Mindfulness-Based Intervention Effect on the Psychophysiological Marker of Self-Regulation in Women With Endometriosis-Related Chronic Pain,” Journal of Pain 25, no. 1 (2024): 118–131, https://doi.org/10.1016/j.jpain.2023.07.026. - 66M. Moreira, O. L. Gamboa, and M. A. Pinho Oliveira, “Cognitive-Affective Changes Mediate the Mindfulness-Based Intervention Effect on Endometriosis-Related Pain and Mental Health: A Path Analysis Approach,” European Journal of Pain 27 (2023): 1187–1202. - 67J. A. Sturgeon and A. J. Zautra, “Psychological Resilience, Pain Catastrophizing, and Positive Emotions: Perspectives on Comprehensive Modeling of Individual Pain Adaptation,” Current Pain and Headache Reports 17, no. 3 (2013): 317, https://doi.org/10.1007/s11916-012-0317-4. - 68A. C. de C Williams and H. McGrigor, “A Thematic Synthesis of Qualitative Studies and Surveys of the Psychological Experience of Painful Endometriosis,” BMC Womens Health 24, no. 1 (2024): 50, https://doi.org/10.1186/s12905-023-02874-3. - 69O. T. Sims, J. Gupta, S. A. Missmer, and I. O. Aninye, “Stigma and Endometriosis: A Brief Overview and Recommendations to Improve Psychosocial Well-Being and Diagnostic Delay,” International Journal of Environmental Research and Public Health 18, no. 15 (2021): 8210, https://doi.org/10.3390/ijerph18158210. - 70L. Coxon, C. Lugt, A. W. Horne, et al., “Symptom Flares in Women With Chronic Pelvic Pain: Questionnaire Study Within a Cohort Study Translational Research in Pelvic Pain (TRiPP),” BJOG 131 (2024): 1832–1840, https://doi.org/10.1111/1471-0528.17915. - 71C. Zarbo, A. Brugnera, V. Dessì, et al., “Cognitive and Personality Factors Implicated in Pain Experience in Women With Endometriosis: A Mixed-Method Study,” Clinical Journal of Pain 35, no. 12 (2019): 948–957. - 72B. Pickup, D. Coutts-Bain, and J. Todd, “Fear of Progression, Depression, and Sleep Difficulties in People Experiencing Endometriosis-Pain: A Cross-Sectional Study,” Journal of Psychosomatic Research 178 (2024): 111595, https://doi.org/10.1016/j.jpsychores.2024.111595. - 73C. Zarbo, A. Brugnera, A. Compare, et al., “Negative Metacognitive Beliefs Predict Sexual Distress Over and Above Pain in Women With Endometriosis,” Archives of Women's Mental Health 22, no. 5 (2019): 575–582, https://doi.org/10.1007/s00737-018-0928-9. - 74C. Zarbo, A. Brugnera, A. Compare, et al., “Psychological and Cognitive Factors Implicated in Pain Experience in Women With Endometriosis,” Health Care for Women International 43 (2022): 142–159, https://doi.org/10.1080/07399332.2021.1959592. - 75M. Stevens, T. Cruwys, and K. Murray, “Social Support Facilitates Physical Activity by Reducing Pain,” British Journal of Health Psychology 25, no. 3 (2020): 576–595, https://doi.org/10.1111/bjhp.12424. - 76C. Zarbo, A. Brugnera, L. Frigerio, et al., “Behavioral, Cognitive, and Emotional Coping Strategies of Women With Endometriosis: A Critical Narrative Review,” Archives of Women's Mental Health 21, no. 1 (2018): 1–13, https://doi.org/10.1007/s00737-017-0779-9. - 77R. Smith, J. F. Thayer, S. S. Khalsa, and R. D. Lane, “The Hierarchical Basis of Neurovisceral Integration,” Neuroscience & Biobehavioral Reviews 75 (2017): 274–296, https://doi.org/10.1016/j.neubiorev.2017.02.003. - 78D. Williams, E. Muth, J. Thayer, T. Chelimsky, and G. Chelimsky, “Does Maladaptive Cardiovagal Modulation Extend to Gastric Modulation in Women With Chronic Pelvic Pain?,” Neurourology and Urodynamics 40, no. 1 (2020): 193–200, https://doi.org/10.1002/nau.24532. - 79S. G. Simon, R. P. Sloan, J. F. Thayer, and L. D. Jamner, “Taking Context to Heart: Momentary Emotions, Menstrual Cycle Phase, and Cardiac Autonomic Regulation,” Psychophysiology 58, no. 4 (2021): e13765, https://doi.org/10.1111/psyp.13765. - 80T. Dalgleish, M. Black, D. Johnston, and A. Bevan, “Transdiagnostic Approaches to Mental Health Problems: Current Status and Future Directions,” Journal of Consulting and Clinical Psychology 88, no. 3 (2020): 179–195, https://doi.org/10.1037/ccp0000482. - 81S. Johnson, A. Bradshaw, R. Bresnahan, E. Evans, K. Herron, and D. K. Hapangama, “Biopsychosocial Approaches for the Management of Female Chronic Pelvic Pain: A Systematic Review,” BJOG: An International Journal of Obstetrics & Gynaecology 132, no. 3 (2024): 266–277, https://doi.org/10.1111/1471-0528.17987. Citing Literature Article Metrics Total unique accesses to an article’s full text in HTML or PDF/ePDF format.More metric information Scite metrics Explore this article's citation statements on scite.ai Share QR Code Generating QR code QR code copied to clipboard! Something went wrong while generating your QR code. Please try again in a moment. If the issue persists, refresh the page or contact support. Export citation Unable to load citation data. Please try again in a moment. How to cite Elkins, L. J., & Spiegelman, M. (2021). pyUserCalc: A revised Jupyter notebook calculator for uranium-series disequilibria in basalts. Earth and Space Science, 8, e2020EA001619. https://doi.org/10.1029/2020EA001619 Download Citation If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click on download. This feature enables you to download the bibliographic information (also called citation data, header data, or metadata) for the articles on our site. Citation manager file format Use the dropdown list to choose how to format the bibliographic data you're harvesting. Several citation manager formats are available, including EndNote and BibTex. You can then copy the formatted citation (as displayed) or download it as file, to your device. If the RefWorks format is chosen, the 'Download' button will be replaced with an option to directly export to RefWorks