L26/P-350 Central sensitization in women with endometriosis: a prospective cohort study

Abstract Study question Do women with symptomatic endometriosis exhibit a higher risk of central sensitization compared with women without endometriosis but affected by other chronic pain syndromes? Summary answer Women with symptomatic endometriosis show significantly higher risk of central sensitization and it is strongly associated with pain severity and impaired quality of life. What is known already Central sensitization is a key mechanism in the development and persistence of chronic pain. Endometriosis, traditionally considered a peripheral organic disease, is increasingly recognized as a complex condition in which dysfunction of central pain modulation plays a relevant role. This mechanism may explain the frequent mismatch between lesion extent and pain severity. Study design, size, duration This was a prospective cohort study including 240 women aged 16–45 years, enrolled between January and December 2025. Participants/materials, setting, methods Participants were recruited at Policlinico Umberto I, Rome. Women with ultrasound-confirmed endometriosis and/or adenomyosis were assigned to Group A (n = 120), while women without endometriosis but diagnosed with at least one chronic pain syndrome were assigned to Group B (n = 120). All participants completed the Central Sensitization Inventory (CSI) and the SF-12 questionnaire. Pain intensity (dysmenorrhea, dyspareunia, and chronic pelvic pain) was assessed using a numerical rating scale. Descriptive, comparative, and multivariate statistical analyses were performed. Main results and the role of chance Mean CSI score was significantly higher in Group A than in Group B (49.5 ± 16.5 vs 36.8 ± 14.4; p < 0.001), exceeding the clinical threshold for central sensitization. In Group A, CSI was directly correlated with the severity of dysmenorrhea, dyspareunia, and chronic pelvic pain (all p < 0.001), whereas no such association was observed in Group B. In Group B, at least two chronic pain syndromes were required to reach CSI levels comparable to those observed in women with isolated endometriosis. The coexistence of endometriosis with irritable bowel syndrome, fibromyalgia, or vulvodynia was associated with a significant increase in CSI, independent of pain intensity. Surgically treated patients showed higher CSI scores than non-operated patients, whereas prolonged hormonal therapy was associated with significantly lower CSI values. No significant correlations were found between CSI and lesion stage, location, or size, although posterior endometriotic fibrosis approached statistical significance. In both groups, CSI was negatively correlated with quality of life. Limitations, reasons for caution The single-center design and the use of self-reported questionnaires may limit generalizability. Causal relationships between central sensitization and clinical variables cannot be fully established. Wider implications of the findings Women with symptomatic endometriosis have a markedly increased risk of central sensitization. These findings support a paradigm shift toward early, preventive, and multidisciplinary management, in which medical therapy and systematic assessment of the central component of pain play a pivotal role in improving quality of life. Trial registration number No