Managing the neuroinflammatory pain of endometriosis in light of chronic pelvic pain

Joseph V Pergolizzi, Jo Ann LeQuang, Flaminia Coluzzi, Salah N El-Tallawy, Peter Magnusson, Rania S Ahmed, Giustino Varrassi, Maria Grazia Porpora
Expert opinion on pharmacotherapy · 2024 · vol. 25(17) , pp. 2267–2282 · doi:10.1080/14656566.2024.2425727 · PMID:39540855 · W4404375357
review OA: closed CC0 ⤵ 2 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

Endometriosis causes chronic pelvic pain through hormonal, angiogenic, and neuroinflammatory processes involving immune cells, and management requires a personalized, multimodal approach including hormonal, pharmacologic, surgical, and psychological treatments.

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Abstract

INTRODUCTION: Endometriosis affects 5% to 10% of reproductive age women and may be associated with severely painful and debilitating symptoms as well as infertility. Endometriosis involves hormonal fluctuations, angiogenesis, neurogenesis, vascular changes and neuroinflammatory processes. The neuroinflammatory component of endometriosis makes it a systemic disorder, similar to other chronic epithelial inflammatory conditions. AREAS COVERED: Inflammatory mediators, mast cells, macrophages, and glial cells play a role in endometriosis which can result in peripheral sensitization and central sensitization. There is overlap between chronic pelvic pain and endometriosis, but the two conditions are distinct. Effective treatment is based on a personalized approach using a variety of pharmacologic and other treatment options. EXPERT OPINION: Hormonal therapies are a first-line approach, but endometriosis is a challenging condition to manage. 'Add-back' hormonal therapy has been effective. Painful symptoms are likely caused by the interplay of multiple factors and there may be a neuropathic component. Analgesics and anticonvulsants may be appropriate. A holistic approach and multimodal treatments are likely to be most effective. In addition to pharmacologic treatment, there are surgical and alternative medicine options. Endometriosis may also have a psychological component.

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Condition tags

mesh:D004715mesh:D017699endometriosischronic_pelvic_paininfertility

MeSH descriptors

Chronic Pain Chronic Pain Chronic Pain Chronic Pain Chronic Pain Chronic Pain Chronic Pain Chronic Pain Chronic Pain Chronic Pain Chronic Pain Chronic Pain Chronic Pain Chronic Pain Chronic Pain Chronic Pain Chronic Pain Endometriosis Endometriosis Endometriosis

Citation neighborhood

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. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (100)

Cited by (2)

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