The role of pain relief in the management of chronic pelvic pain in deep endometriosis

The role of pain relief in the management of chronic pelvic pain in deep endometriosis

Gilberto Pari, Gianfranco Sindaco, Marco La Grua – Orcid, Valentina Paci, Matteo Zanella – Orcid, Alberto Merlini Orcid, Simone Vigneri – Orcid

Interdisciplinary Operative Unit of Pain Medicine and Therapy. Regional Reference Center – Accredited Hospital of Santa Maria Maddalena, Rovigo

Advanced Algology Research – Recognized association for scientific research, Rimini

Corresponding Author: Gilberto Pari

g.pari@medicinadeldolore.org


DOI: 10.53146/lriog1202139

Abstract

In some patients endometriosis causes persistent or chronic pain, becoming a specialistic algologic problem. Considering various possible pathogenic pain mechanisms, when pain therapy of endometriosis cannot be etiologic, far from being only symptomatic, it is based on a pathogenetic criterion. We must consider that in endometriosis pain can be due to activation of nociceptors sensibilized by endometriosic tissues (tissutal nociceptive pain), unresponding to NSAIDs and opioids, or to the nerve damage by nerve compression from endometriosic cistis or by involvement of nerve structures in scar tissue (neuropathic pain), unresponding to antinociceptive therapy but responding, at least partially, to some neuropathic specific pain drugs and to electrostimulation of the nervous system. And finally, we can have nociplastic pain, where cerebral and spinal neuroplasticity is the main mechanism causing pain: when facing this type of pain, the only effective management should follow a biopsychosocial and interdisciplinary model.

Keywords: endometriosis; chronic pelvic pain; pain therapy; interdisciplinary management.


Available in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283


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