Pain in Endometriosis

Jessica Maddern; Luke Grundy; Joel Castro; Stuart M Brierley

doi:10.3389/fncel.2020.590823

Pain in Endometriosis

Front Cell Neurosci. 2020 Oct 6:14:590823. doi: 10.3389/fncel.2020.590823. eCollection 2020.

Authors

Jessica Maddern^{1

2}, Luke Grundy^{1

2}, Joel Castro^{1

2}, Stuart M Brierley^{1

2

3}

Affiliations

¹ Visceral Pain Research Group, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia.
² Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
³ Discipline of Medicine, University of Adelaide, North Terrace Campus, Adelaide, SA, Australia.

Abstract

Endometriosis is a chronic and debilitating condition affecting ∼10% of women. Endometriosis is characterized by infertility and chronic pelvic pain, yet treatment options remain limited. In many respects this is related to an underlying lack of knowledge of the etiology and mechanisms contributing to endometriosis-induced pain. Whilst many studies focus on retrograde menstruation, and the formation and development of lesions in the pathogenesis of endometriosis, the mechanisms underlying the associated pain remain poorly described. Here we review the recent clinical and experimental evidence of the mechanisms contributing to chronic pain in endometriosis. This includes the roles of inflammation, neurogenic inflammation, neuroangiogenesis, peripheral sensitization and central sensitization. As endometriosis patients are also known to have co-morbidities such as irritable bowel syndrome and overactive bladder syndrome, we highlight how common nerve pathways innervating the colon, bladder and female reproductive tract can contribute to co-morbidity via cross-organ sensitization.

Keywords: chronic pelvic pain; hyperalgesia; inflammation; neuroangiogenesis; peripheral sensitization; sensory afferents; uterus; vagina.

Publication types

Review