Peripheral changes in endometriosis-associated pain
Open accessAbstract
BACKGROUND: Pain remains the cardinal symptom of endometriosis. However, to date, the underlying mechanisms are still only poorly understood. Increasing evidence points towards a close interaction between peripheral nerves, the peritoneal environment and the central nervous system in pain generation and processing. Recently, studies demonstrating nerve fibres and neurotrophic and angiogenic factors in endometriotic lesions and their vicinity have led to increased interest in peripheral changes in endometriosis-associated pain. This review focuses on the origin and function of these nerves and factors as well as possible peripheral mechanisms that may contribute to the generation and modulation of pain in women with endometriosis. METHODS: We conducted a systematic search using several databases (PubMed, MEDLINE, EMBASE and CINAHL) of publications from January 1977 to October 2013 to evaluate the possible roles of the peripheral nervous system in endometriosis pathophysiology and how it can contribute to endometriosis-associated pain. RESULTS: Endometriotic lesions and peritoneal fluid from women with endometriosis had pronounced neuroangiogenic properties with increased expression of new nerve fibres, a shift in the distribution of sensory and autonomic fibres in some locations, and up-regulation of several neurotrophins. In women suffering from deep infiltrating endometriosis and bowel endometriosis, in which the anatomical distribution of lesions is generally more closely related to pelvic pain symptoms, endometriotic lesions and surrounding tissues present higher nerve fibre densities compared with peritoneal lesions and endometriomas. More data are needed to fully confirm a direct correlation between fibre density in these locations and the amount of perceived pain. A better correlation between the presence of nerve fibres and pain symptoms seems to exist for eutopic endometrium. However, this appears not to be exclusive to endometriosis. No correlation between elevated neurotrophin levels and pain severity appears to exist, suggesting the involvement of other mediators in the modulation of pain. CONCLUSIONS: The increased expression of neurotrophic factors and nerve fibres in endometriotic lesions, eutopic endometrium and the peritoneum imply a role of such peripheral changes in the pathogenesis of endometriosis-associated pain. However, a clear link between these findings and pain in patients with endometriosis has so far not been demonstrated.
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Endometriosis-related pain is under the influence of hormonal aberrations, stress, inflammation, and the interplay between the peripheral and central nervous systems.
“under the influence of hormonal aberrations, stress, inflammation, and the interplay between the peripheral and central nervous systems [129–131].”
From Hormonal treatments for endometriosis: The endocrine background (2022) · cites this paper as [130]
The Introduction and the sections on estrogens and peripheral pain mechanisms support roles for estrogen, inflammation, and interactions between the peripheral and central nervous systems in endometriosis-associated pain. Our copy does not establish stress as an influence on that pain; the autonomic-nervous-system section discusses the HPA axis and inflammation but does not make that link. (LLM, conf=0.85)
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Mechanisms of pain in endometriosis
Morotti, M., Vincent, K., & Becker, C. M. (2017) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2016.07.497 · Cited by 255 · see citing works
Self-citationPathogenetic Mechanisms of Deep Infiltrating Endometriosis
Tosti, C., Pinzauti, S., Santulli, P., Chapron, C., & Petraglia, F. (2015) · Reproductive Sciences · doi:10.1177/1933719115592713 · Cited by 222 · see citing works
Menstruation pulls the trigger for inflammation and pain in endometriosis
Laux-Biehlmann, A., d’Hooghe, T., & Zollner, T. M. (2015) · Trends in Pharmacological Sciences · doi:10.1016/j.tips.2015.03.004 · Cited by 150 · see citing works
Morotti, M., Sozzi, F., Remorgida, V., Venturini, P. L., & Ferrero, S. (2014) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2014.10.036 · Cited by 84 · see citing works
Self-citationVannuccini, S., Lazzeri, L., Orlandini, C., Morgante, G., Bifulco, G., Fagiolini, A., & Petraglia, F. (2018) · Journal of Psychosomatic Obstetrics & Gynecology · doi:10.1080/0167482x.2017.1386171 · Cited by 82 · see citing works
Yong, P. J. (2017) · Sexual Medicine Reviews · doi:10.1016/j.sxmr.2017.06.005 · Cited by 68 · see citing works
The clinical significance of endocannabinoids in endometriosis pain management
Bouaziz, J., Bar On, A., Seidman, D. S., & Soriano, D. (2017) · Cannabis and Cannabinoid Research · doi:10.1089/can.2016.0035 · Cited by 65 · see citing works
Carrarelli, P., Luddi, A., Funghi, L., Arcuri, F., Batteux, F., Dela Cruz, C., Tosti, C., Reis, F. M., Chapron, C., & Petraglia, F. (2016) · Reproductive BioMedicine Online · doi:10.1016/j.rbmo.2016.07.009 · Cited by 51 · see citing works
Morotti, M., Venturini, P. L., Biscaldi, E., Racca, A., Calanni, L., Vellone, V. G., Stabilini, C., & Ferrero, S. (2017) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2017.03.033 · Cited by 43 · see citing works
Self-citationTaylor, H. S., Dun, E. C., & Chwalisz, K. (2019) · Pain Management · doi:10.2217/pmt-2019-0010 · Cited by 38 · see citing works
van Aken, M., Oosterman, J., van Rijn, T., Woudsma, K., Ferdek, M., Ruigt, G., Kozicz, T., Braat, D., Peeters, A., & Nap, A. (2018) · Fertility and Sterility · doi:10.1016/j.fertnstert.2018.06.040 · Cited by 26 · see citing works
- Authors
- Morotti, M., Vincent, K., Brawn, J., Zondervan, K. T., & Becker, C. M.
- Affiliations
- John Radcliffe Hospital (GB)
- Centre for Human Genetics (GB)
- Venue
- Human Reproduction Update
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-05-23
- Volume
- 20
- Issue
- 5
- Pages
- 717-736
- ISSN
- 1355-4786 (ISSN-L)
- 1460-2369
- PMC
- PMC4337970
- OpenAlex
- W2147418200
- Cited by
- 198
- References
- 212
- Citations by year
- 2026: 11 · 2025: 19 · 2024: 16 · 2023: 16 · 2022: 14 · 2021: 26 · 2020: 18 · 2019: 15 · 2018: 13 · 2017: 17 · 2016: 18 · 2015: 12 · 2014: 3
- FWCI
- 2.61
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Human Reproduction Update (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Wellcome Trust (085235, 090532)
- National Institute for Health and Care Research (CL-2008-13-002)
- Academy of Medical Sciences (AMS-SGCL8-Vincent)
- Medical Research Council (MR/K011480/1)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- endometriosis, endometriosis-associated pain, peripheral nervous system, nerve fibers, neurotrophins, angiogenic factors, deep infiltrating endometriosis, bowel endometriosis, endometrioma, eutopic endometrium, peritoneum, pain modulation
- MeSH terms
- Ascitic Fluid, Endometriosis, Endometrium, Female, Humans, Neovascularization, Pathologic, Nerve Fibers, Pain, Neurogenesis
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