[Endometriosis and chronic overlapping pain conditions]

Abstract

Background: The concept of chronic overlapping pain conditions (COPC) is relatively unknown in German pain medicine.

Aims: Definition, prevalence, shared etiological and pathophysiological mechanisms of COPC. Summary of recommendations of the interdisciplinary S2k guidelines on diagnostics and treatment of endometriosis relevant for pain physicians.

Methods: Selective search of literature in PubMed and selection of recommendations of the S2k guidelines on diagnostics and treatment of endometriosis.

Results: According to the US National Institutes of Health, COPCs comprise chronic fatigue syndrome, chronic (unspecific) low back pain, chronic tension headache, endometriosis, fibromyalgia syndrome, migraine, painful bladder syndrome, temporomandibular disorder and vulvodynia. Shared etiological factors are family aggregation, childhood adversities and major or traumatic life events. A major shared pathophysiological mechanism is altered processing of stimuli in the central nervous system. Patients with endometriosis should be screened for other chronic pain conditions and psychological distress. The physical examination should check for local (myofascial trigger points) and generalized signs of hyperalgesia and allodynia indicating central sensitization. In cases of endometriosis with COPCs repeated surgery for pain relief should be avoided. Amitriptyline and duloxetine can be considered as pharmacological treatment options.

Discussion: Pain physicians can play a role in the management of patients with endometriosis and COPCs. A multimodal therapy should include physiotherapy and pain-related psychological treatment and possibly centrally acting pain modulation medication.

Keywords: Central nervous system sensitization; Chronic overlapping pain conditions/physiopathology; Chronic pain; Combined modality therapy; Guidelines as topic.