Central and Peripheral Pain Generators in Women with Chronic Pelvic Pain: Patient Centered Assessment and Treatment

Donna Hoffman, Hoffman D
Current rheumatology reviews · 2015 · vol. 11(2) , pp. 146–166 · doi:10.2174/1573397111666150619094524 · PMID:26088216 · W2239519396
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This paper examines how central and peripheral pain generators contribute to chronic pelvic pain in women, proposing a patient-centered, multidisciplinary approach to manage this systemic disease process.

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⚙ AI-generated deep summary by claude@2026-07, 2026-07-09 · read from full text ⓘ

The paper addresses women with chronic pelvic pain (CPP) in whom imaging, laboratory tests, and physical exams often do not identify an obvious cause, proposing that dysfunctional sensory processing in the central nervous system (central sensitization) can explain pain of unclear origin. It describes how central (CNS-mediated) and peripheral (local tissue damage) pain generators can coexist across CPP patients and emphasizes that multiple co-occurring pain conditions—such as endometriosis, painful bladder syndrome/interstitial cystitis, vulvodynia, myofascial pain/pelvic floor hypertonus, irritable bowel syndrome, and primary dysmenorrhea—may share central sensitization. The paper outlines a patient-centered, multi-disciplinary assessment and treatment approach focused on improving emotional, physical, and social functioning and recognizes chronic dysfunctional sensory processing as a systemic process to be managed rather than “fixed,” but it does not present new experimental results. This paper is centrally about endometriosis — endometriosis is listed among six common co-existing chronic pain disorders in CPP that can involve both central and peripheral pain generators.

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Abstract

Women with chronic pelvic pain (CPP) often present without obvious cause on imaging studies, laboratory values or physical exam. Dysfunctional sensory processing in the central nervous system (CNS) may explain pain of unclear origin. Central sensitization (CS), a mechanism of centrally mediated pain, describes this abnormal processing of sensory information. Women with CPP often present with several seemingly unrelated symptoms. This can be explained by co-existing chronic pain syndromes occurring in the same patient. Central sensitization occurs in all of these pain syndromes, also described as dysfunctional pain syndromes, and thus may explain why several often occur in the same patient. Six of the most common pain disorders that co-exist in CPP include endometriosis, painful bladder syndrome/interstitial cysitis, vulvodynia, myofascial pain/ pelvic floor hypertonus, irritable bowel syndrome, and primary dysmenorrhea. Central pain generators, (pain originating from CS) and peripheral pain generators, (pain from local tissue damage), can both occur in each of these six conditions. These pain generators will be described. Chronic pain, specifically dysfunctional sensory processing, is recognized as a systemic disease process like diabetes to be managed as opposed to a local problem to be "fixed" or cured. A multi-disciplinary approach to assessment and treatment with a focus on improving emotional, physical and social functioning instead of focusing strictly on pain reduction is more effective in decreasing disability. This is best achieved by determining the patient's needs and perspective through a patient-centered approach. Algorithms for such an approach to assessment and treatment are outlined.
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Keywords

Central sensitization, chronic pelvic pain, fear- avoidance, multi-disciplinary treatment, pain catastrophizing, patient –centered care, pelvic floor hypertonus.

Abstract

Women with chronic pelvic pain (CPP) often present without obvious cause on imaging studies, laboratory values or physical exam. Dysfunctional sensory processing in the central nervous system (CNS) may explain pain of unclear origin. Central sensitization (CS), a mechanism of centrally mediated pain, describes this abnormal processing of sensory information. Women with CPP often present with several seemingly unrelated symptoms. This can be explained by co-existing chronic pain syndromes occurring in the same patient. Central sensitization occurs in all of these pain syndromes, also described as dysfunctional pain syndromes, and thus may explain why several often occur in the same patient. Six of the most common pain disorders that co-exist in CPP include endometriosis, painful bladder syndrome/interstitial cysitis, vulvodynia, myofascial pain/ pelvic floor hypertonus, irritable bowel syndrome, and primary dysmenorrhea. Central pain generators, (pain originating from CS) and peripheral pain generators, (pain from local tissue damage), can both occur in each of these six conditions. These pain generators will be described. Chronic pain, specifically dysfunctional sensory processing, is recognized as a systemic disease process like diabetes to be managed as opposed to a local problem to be “fixed” or cured. A multi-disciplinary approach to assessment and treatment with a focus on improving emotional, physical and social functioning instead of focusing strictly on pain reduction is more effective in decreasing disability. This is best achieved by determining the patient’s needs and perspective through a patient-centered approach. Algorithms for such an approach to assessment and treatment are outlined.

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Condition tags

dysmenorrheaendometriosischronic_pelvic_painirritable_bowel_syndrome

MeSH descriptors

Chronic Pain Chronic Pain Chronic Pain Chronic Pain Chronic Pain Pelvic Pain Pelvic Pain Pelvic Pain Pelvic Pain Pelvic Pain Central Nervous System Sensitization Cystitis, Interstitial Cystitis, Interstitial Dysmenorrhea Dysmenorrhea Endometriosis Endometriosis Facial Pain Facial Pain Female

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