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Cited by 91Endometriosis Research and TreatmentPain Mechanisms and TreatmentsMusculoskeletal pain and rehabilitation

Reduced pain thresholds and signs of sensitization in women with persistent pelvic pain and suspected endometriosis

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Grundström, Hanna, Gerdle, Björn, Alehagen, Siw, Berterö, Carina, Arendt‐Nielsen, Lars, Kjølhede, Preben·2019·Acta Obstetricia et Gynecologica Scandinavica
DOI 10.1111/aogs.13508
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Abstract

Introduction: Endometriosis is a gynecological disorder that may cause considerable pelvic pain in women of fertile age. Determining pain mechanisms is necessary in order to optimize the treatment of the disease. The objective of the study was to evaluate pain thresholds in women with persistent pelvic pain with and without confirmed endometriosis, and healthy, unaffected controls, and analyze how pain thresholds in these cohorts related to duration of pelvic pain, quality of life, and symptoms of anxiety and depression. Material and methods: Pain thresholds for heat, cold and pressure were assessed with quantitative sensory testing on six locations on a reference group of 55 healthy women and on 37 women with persistent pelvic pain who had been admitted for diagnostic laparoscopy on the suspicion of endometriosis. Validated instruments were applied to assess quality of life and symptoms of anxiety and depression. Data were analyzed by means of uni‐ and multivariate analysis of variance and Spearman's rank‐order correlation. Results: The women with persistent pelvic pain had significantly lower pain thresholds compared with the reference women. In the women with pain, no differences were observed in pain thresholds between women with (n = 13) and women without (n = 24) biopsy‐proven endometriosis. The duration of pelvic pain correlated significantly positively with reduced pain thresholds, ie, the longer the duration, the more sensitization. In the persistent pelvic pain group, pain thresholds for heat correlated significantly with the Short Form Health Survey 36 dimension of bodily pain, and thresholds for cold correlated with Short Form Health Survey 36 bodily pain and with symptoms of depression. Conclusions: Our results showed widespread alterations in pain thresholds in women with persistent pelvic pain that are indicative of central sensitization and a time‐dependent correlation. Women with pelvic pain and suspicion of endometriosis should probably be treated more thoroughly to prevent or at least minimize the concomitant development of central sensitization.

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  • Residual adenomyosis and peripheral and central sensitization influence autonomous nerve function and have implications for GI function.

    “Residual adenomyosis and peripheral and central sensitization has been shown to influence autonomous nerve function and will therefore also have implications on GI function. 41 , 42”

    From Gastrointestinal function outcomes following radical and conservative colorectal surgery for deep endometriosis: A systematic review and meta‐analysis (2025) · cites this paper as [42]

    The Discussion (page unavailable) reports signs of central sensitization in women with persistent pelvic pain and discusses peripheral sensitization as a possible explanation for localized pain sensitivity. It does not address residual adenomyosis or show that sensitization affects autonomic nerve function or GI function. (LLM, conf=0.86)

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  • The lack of relevant differences in changes of GI function following segmental resection and conservative surgery may be explained by postsurgical GI function not solely depending on surgical technique but on the degree of overall radicality of removal of disease including adenomyosis and deep endometriosis affecting other sites.

    “First and foremost, postsurgical GI function may not solely depend on the surgical technique but on the degree of overall radicality of removal of disease including adenomyosis and DE affecting other sites.”

    From Gastrointestinal function outcomes following radical and conservative colorectal surgery for deep endometriosis: A systematic review and meta‐analysis (2025) · cites this paper as [42]

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Authors
Grundström, H., Gerdle, B., Alehagen, S., Berterö, C., Arendt‐Nielsen, L., & Kjølhede, P.
Affiliations
  • Linköping University (SE)
  • Aalborg University (DK)
Corresponding author
Grundström, Hanna
ORCID
Venue
Acta Obstetricia et Gynecologica Scandinavica
Publisher
Wiley
Published
2018-12-30
Volume
98
Issue
3
Pages
327-336
ISSN
  • 0001-6349 (ISSN-L)
  • 1600-0412
DOI
10.1111/aogs.13508
OpenAlex
W2900796047
Cited by
91
References
27
Citations by year
2026: 7 · 2025: 13 · 2024: 18 · 2023: 10 · 2022: 12 · 2021: 11 · 2020: 14 · 2019: 5
FWCI
8.01
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Acta Obstetricia Et Gynecologica Scandinavica (publishedVersion)
  • PubMed (publishedVersion)
  • VBN Forskningsportal (Aalborg Universitet) (publishedVersion, other-oa)
  • DiVA (Linkoping University) (submittedVersion, other-oa)
Funders
  • Forskningsrådet i Sydöstra Sverige
  • Linköpings Universitet
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
  • Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Keywords
endometriosis, persistent pelvic pain, pain threshold, central sensitization, quantitative sensory testing, pain duration, quality of life, depression, anxiety, thermal pain, cold pain, pressure pain
MeSH terms
Adult, Anxiety, Endometriosis, Female, Humans, Middle Aged, Pain Measurement, Quality of Life, Severity of Illness Index, Pain Threshold, Pelvic Pain

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