Central changes associated with chronic pelvic pain and endometriosis

Jennifer Brawn, Matteo Morotti, Krina T Zondervan, Christian M Becker, Katy Vincent
Human reproduction update · 2014 · vol. 20(5) , pp. 737–747 · doi:10.1093/humupd/dmu025 · PMID:24920437 · W2136897269
review OA: bronze CC0 ⤵ 180 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

Chronic pelvic pain in women is linked to central nervous system changes including altered responses to pain, structural brain modifications, hypothalamic-pituitary-adrenal axis and autonomic nervous system dysfunction, and psychological distress.

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Abstract

BACKGROUND: Chronic pelvic pain (CPP) is a significant public health problem with 1 million affected women in the UK. Although many pathologies are associated with CPP, the pain experienced is often disproportionate to the extent of disease identified and frequently no pathology is found (chronic pelvic pain syndrome). The central nervous system (CNS) is central to the experience of pain and chronic pain conditions in general are associated with alterations in both the structure and function of the CNS. This review describes the available evidence for central changes in association with conditions presenting with CPP. METHODS: A detailed literature search was performed to identify relevant papers, however, this is not a systematic review. RESULTS: CPP is associated with central changes similar to those identified in other pain conditions. Specifically these include, alterations in the behavioural and central response to noxious stimulation, changes in brain structure (both increases and decreases in the volume of specific brain regions), altered activity of both the hypothalamic-pituitary-adrenal axis and the autonomic nervous system (ANS) and psychological distress. CONCLUSIONS: The evidence reviewed in this paper demonstrates that CPP is associated with significant central changes when compared with healthy pain-free women. Moreover, the presence of these changes has the potential to both exacerbate symptoms and to predispose these women to the development of additional chronic conditions. These findings support the use of adjunctive medication targeting the CNS in these women.

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Condition tags

mesh:D004715mesh:D017699endometriosischronic_pelvic_pain

MeSH descriptors

Chronic Pain Endometriosis Pelvic Pain Brain Brain Brain Chronic Pain Chronic Pain Chronic Pain Chronic Pain Endometriosis Endometriosis Female Humans Hypothalamo-Hypophyseal System Hypothalamo-Hypophyseal System Pelvic Pain Pelvic Pain Pelvic Pain Pelvic Pain

Citation neighborhood

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References (100)

Cited by (50)

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