Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications

Pamela Stratton, Stratton P, Berkley KJ, Karen J. Berkley, K. J. Berkley
Human Reproduction Update · 2010 · vol. 17(3) , pp. 327–346 · doi:10.1093/humupd/dmq050 · PMID:21106492 · PMC3072022 · W2128514007
Review OA: bronze CC0 ⤵ 343 in-corpus citations
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This review explores how endometriotic lesions interact with the central nervous system, potentially causing pain independent of lesion characteristics and suggesting a shift in research focus from lesions to pain mechanisms.

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Abstract

BACKGROUND: Many clinicians and patients believe that endometriosis-associated pain is due to the lesions. Yet causality remains an enigma, because pain symptoms attributed to endometriosis occur in women without endometriosis and because pain symptoms and severity correlate poorly with lesion characteristics. Most research and reviews focus on the lesions, not the pain. This review starts with the recognition that the experience of pain is determined by the central nervous system (CNS) and focuses on the pain symptoms. METHODS: Comprehensive searches of Pubmed, Medline and Embase were conducted for current basic and clinical research on chronic pelvic pain and endometriosis. The information was mutually interpreted by a basic scientist and a clinical researcher, both in the field of endometriosis. The goal was to develop new ways to conceptualize how endometriosis contributes to pain symptoms in the context of current treatments and the reproductive tract. RESULTS: Endometriotic lesions can develop their own nerve supply, thereby creating a direct and two-way interaction between lesions and the CNS. This engagement provides a mechanism by which the dynamic and hormonally responsive nervous system is brought directly into play to produce a variety of individual differences in pain that can, in some women, become independent of the disease itself. CONCLUSIONS: Major advances in improving understanding and alleviating pain in endometriosis will likely occur if the focus changes from lesions to pain. In turn, how endometriosis affects the CNS would be best examined in the context of mechanisms underlying other chronic pain conditions.

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Condition tags

endometriosischronic_pelvic_pain

MeSH descriptors

Endometriosis Pelvic Pain Animals Animals Central Nervous System Central Nervous System Central Nervous System Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometrium Endometrium Endometrium Female Female Humans Humans Menstruation Disturbances

Citation neighborhood (2-hop)

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

References (100)

Cited by (50)

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