Pain syndrome features in different forms of external genital endometriosis: a cross-sectional study

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Objective: To assess pain syndrome in patients with different forms of external genital endometriosis.

Materials and methods: The one-stage study was conducted at the V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology & Perinatology of the Ministry of Health of the Russian Federation from 2021 to 2023, involving 200 patients (age 32.03 (7.15) years) with confirmed endometriosis through expert ultrasonography and magnetic resonance imaging of the pelvic organs. Patients were categorized into three groups based on the form of endometriosis: with peritoneal endometriosis (SUP), endometriomas (OMA), and deep endometriosis (DE); in case of combined pathology inclusion in one or another group was carried out according to the most severe form. The targeted history collection of women was conducted through questioning. The intensity of the pain syndrome was evaluated using the visual analog scale (VAS), followed by calculation of the pelvic pain index (PPI). The level of central sensitization (CS) was assessed using the CSI scale, and quality of life and sexual function were evaluated using the SF-12 questionnaire and 5-point Likert scale, respectively. Neuropathic components were assessed based on the results of the PainDetect questionnaire.

Results: Data analysis revealed that patients with OMA were predominantly not characterized by pain syndrome. The severity of dysmenorrhea, chronic pelvic pain, and PPI, according to VAS indicators, was minimal in isolated endometriomas, with a tendency for higher PPI when endometriomas were combined with SUP, DE, and all three forms of endometriosis, respectively. PPI determination revealed that a threshold score of ≥3.8 points can indicate the presence of DE. Additionally, a significant level of sensitization (≥40 points) was observed in nearly one in two women with DE, one in three women with SUP, and one in six women with OMA. The presence of a neuropathic component was generally less common in patients with endometriosis (5.0%).

Conclusion: The study results demonstrated that not only the presence of pain but also the degree of its severity play a significant role in the diagnosis of endometriosis. PPI can serve as a tool to identify women at risk of endometriosis at the outpatient examination stage. A PPI score ≥3.8 points may indicate DE. The study results led to the conclusion that CS significantly contributes to pain genesis in patients with endometriosis-associated pelvic pain, while the neuropathic component plays a lesser role.

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作者简介

Veronika Pronina

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

Email: ver22595@yandex.ru
ORCID iD: 0000-0003-4566-4065

Obstetrician-Gynecologist, PhD student

俄罗斯联邦, Moscow

Galina Chernukha

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

编辑信件的主要联系方式.
Email: c-galina1@yandex.ru
ORCID iD: 0000-0002-9065-5689

Dr. Med. Sci., Professor, Chief Researcher, Obstetrician-Gynecologist at the Department of Gynecological Endocrinology

俄罗斯联邦, Moscow

Elena Filatova

I.M. Sechenov First Moscow State Medical University of Ministry of Health of Russia (Sechenov University)

Email: eg-filatova@mail.ru
ORCID iD: 0000-0001-9978-4180

Neurologist, Dr. Med. Sci., Professor at the Department of Neurological Diseases

俄罗斯联邦, Moscow

Alina Solopova

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

Email: a_solopova@oparina4.ru
ORCID iD: 0000-0003-4768-115X

Dr. Med. Sci., Leading Researcher at the Department of Radiology

俄罗斯联邦, Moscow

参考

  1. Signorile P.G., Cassano M., Viceconte R., Marcattilj V., Baldi A. Endometriosis: a retrospective analysis of cinical data from a cohort of 4,083 patients, with focus on symptoms. In vivo. 2022; 36(2): 874-83. https://dx.doi.org/10.21873/invivo.12776.
  2. Vercellini P., Fedele L., Aimi G., Pietropaolo G., Consonni D., Crosignani P.G. Association between endometriosis stage, lesion type, patient characteristics and severity of pelvic pain symptoms: a multivariate analysis of over 1000 patients. Hum. Reprod. 2007; 22(1): 266-71. https://dx.doi.org/10.1093/humrep/ del339.
  3. Abbott J., Hawe J., Hunter D., Holmes M., Finn P., Garry R. Laparoscopic excision of endometriosis: a randomized, placebo-controlled trial. Fertil. Steril. 2004; 82(4): 878-84. https://dx.doi.org/1010.1016/j.fertnstert.2004.03.046.
  4. Cetera G.E., Merli C.E.M., Facchin F., Viganò P., Pesce E., Caprara F., Vercellini P. Non-response to first-line hormonal treatment for symptomatic endometriosis: overcoming tunnel vision. A narrative review. BMC Womens Health. 2023; 23(1): 347. https://dx.doi.org/1010.1186/s12905-023-02490-1.
  5. Maddern J., Grundy L., Castro J., Brierley S.M. Pain in endometriosis. Front. Cell. Neurosci. 2020; 14: 590823. https://dx.doi.org/10.3389/fncel.2020.590823.
  6. Surrey E.S., Soliman A.M., Johnson S.J., Davis M., Castelli-Haley J., Snabes M.C. Risk of developing comorbidities among women with endometriosis: A retrospective matched cohort study. J. Womens Health (Larchmt). 2018; 27(9): 1114-23. https://dx.doi.org/10.1089/jwh.2017.6432.
  7. Zhao H., Zhang J., Bao ZL., Kong J., Wei W., Gu J.Q. A preoperative predictive model for stage IV endometriosis. J. Obstet. Gynaecol. 2023; 43(1): 2188072. https://dx.doi.org/1010.1080/01443615.2023.2188072.
  8. Schliep K.C., Mumford S.L., Peterson C.M., Chen Z., Johnstone E.B., Sharp H.T. et al. Pain typology and incident endometriosis. Hum. Reprod. 2015; 30(10): 2427-38. https://dx.doi.org/10.1093/humrep/dev147.
  9. Conroy I., Mooney S.S., Kavanagh S., Duff M., Jakab I., Robertson K. et al. Pelvic pain: What are the symptoms and predictors for surgery, endometriosis and endometriosis severity. Aust. N. Z. J. Obstet. Gynaecol. 2021; 61(5): 765-72. https://dx.doi.org/10.1111/ajo.13379.
  10. Chen C.X., Carpenter J.S., Ofner S., LaPradd M., Fortenberry J.D. Dysmenorrhea symptom-based phenotypes: A replication and extension study. Nurs. Res. 2021; 70(1): 24-33. https://dx.doi.org/10.1097/ NNR.0000000000000477.
  11. Agarwal S.K., Antunez-Flores O., Foster W.G., Hermes A., Golshan S., Soliman A.M. et al. Real-world characteristics of women with endometriosis-related pain entering a multidisciplinary endometriosis program. BMC Womens Health. 2021; 21(1): 19. https://dx.doi.org/10.1186/s12905-020-01139-7.
  12. Khan K.N., Kitajima M., Fujishita A., Hiraki K., Matsumoto A., Nakashima M., Masuzaki H. Pelvic pain in women with ovarian endometrioma is mostly associated with coexisting peritoneal lesions. Hum. Reprod. 2013; 28(1): 109-18. https://dx.doi.org/10.1093/humrep/ des364.
  13. Perelló M., Martínez-Zamora M.A., Torres X., Munrós J., Llecha S., De Lazzari E. et al. Markers of deep infiltrating endometriosis in patients with ovarian endometrioma: a predictive model. Eur. J. Obstet. Gynecol. Reprod. Biol. 2017; 209: 55-60. https://dx.doi.org/10.1016/j.ejogrb.2015.11.024.
  14. Пронина В.А., Думановская М.Р., Чернуха Г.Е. Оптимизация принципов ранней диагностики эндометриоза на основе оценки коморбидности и клинической манифестации. Акушерство и гинекология. 2023; 4: 87-96. [Pronina V.A., Dumanovskaya M.R., Chernukha G.E. Principles of early diagnosis of endometriosis based on the assessment of comorbidity and clinical manifestations. Obstetrics and Gynecology. 2023; (4): 87-96. (in Russian)]. https://dx.doi.org/10.18565/ aig.2023.9.
  15. Chapron C., Lafay-Pillet M.C., Santulli P., Bourdon M., Maignien C., Gaudet-Chardonnet A. et al. A new validated screening method for endometriosis diagnosis based on patient questionnaires. EClinicalMedicine. 2022; 44: 101263. https://dx.doi.org/10.1016/j.eclinm.2021.101263.
  16. Ballard K.D., Seaman H.E., de Vries C.S., Wright J.T. Can symptomatology help in the diagnosis of endometriosis? Findings from a national case-control study--Part 1. BJOG. 2008; 115(11): 1382-91. https://dx.doi.org/10.1111/ j.1471-0528.2008.01878.x.
  17. Fauconnier A., Drioueche H., Huchon C., Du Cheyron J., Indersie E., Candau Y. et al. Early identification of women with endometriosis by means of a simple patient-completed questionnaire screening tool: a diagnostic study. Fertil. Steril. 2021; 116(6): 1580-9. https://dx.doi.org/10.1016/j.fertnstert.2021.07.1205.
  18. Verket N.J., Falk R.S., Qvigstad E., Tanbo T.G., Sandvik L. Development of a prediction model to aid primary care physicians in early identification of women at high risk of developing endometriosis: cross-sectional study. BMJ Open. 2019; 9(12): e030346. https://dx.doi.org/10.1136/bmjopen-2019-030346.
  19. Ricci G., Castelpietra E., Romano F., Di Lorenzo G., Zito G., Ronfani L. et al. Case-control study to develop and validate a questionnaire for the secondary prevention of endometriosis. PLoS One. 2020; 15(3): e0230828. https://dx.doi.org/10.1371/journal.pone.0230828.
  20. Bazot M., Bharwani N., Huchon C., Kinkel K., Cunha T.M., Guerra A. et al. European Society of Urogenital Radiology (ESUR) guidelines: MR imaging of pelvic endometriosis. Eur. Radiol. 2017; 27(7): 2765-75. https://dx.doi.org/10.1007/s00330-016-4673-z.
  21. Méndez Fernández R., Barrera Ortega J. Magnetic resonance imaging of pelvic endometriosis. Radiologia. 2017; 59(4): 286-96. https://dx.doi.org/10.1016/ j.rx.2017.02.002.
  22. Khashchenko E.P., Uvarova E.V., Fatkhudinov T.K., Chuprynin V.D., Asaturova A.V., Kulabukhova E.A. et al. Endometriosis in adolescents: diagnostics, clinical and laparoscopic features. J. Clin. Med. 2023; 12(4): 1678. https://dx.doi.org/ 10.3390/jcm12041678.
  23. Maciel C., Ferreira H., Djokovic D., Kyaw Tun J., Keckstein J., Rizzo S., Manganaro L. MRI of endometriosis in correlation with the #Enzian classification: applicability and structured report. Insights Imaging. 2023; 14(1): 120. 10.1186/s13244-023-01466-x.
  24. Manganaro L., Fierro F., Tomei A., Irimia D., Lodise P., Sergi M.E. et al. Feasibility of 3.0T pelvic MR imaging in the evaluation of endometriosis. Eur. J. Radiol. 2012; 81(6): 1381-7. https://dx.doi.org/10.1016/ j.ejrad.2011.03.049.
  25. Thomeer M.G., Steensma A.B., van Santbrink E.J., Willemssen F.E., Wielopolski P.A., Hunink M.G. et al. Can magnetic resonance imaging at 3.0-Tesla reliably detect patients with endometriosis? Initial results. J. Obstet. Gynaecol. Res. 2014; 40(4): 1051-8. https://dx.doi.org/10.1111/jog.12290.
  26. Freynhagen R., Tölle T.R., Gockel U., Baron R. The painDETECT project - far more than a screening tool on neuropathic pain. Curr. Med. Res. Opin. 2016; 32(6): 1033-57. https://dx.doi.org/10.1185/ 03007995.2016.1157460.
  27. Neblett R., Hartzell M.M., Mayer T.G., Cohen H., Gatchel R.J. Establishing clinically relevant severity levels for the central sensitization inventory. Pain Pract. 2017; 17(2): 166-75. https://dx.doi.org/10.1111/ papr.12440.
  28. Gandek B., Ware J.E., Aaronson N.K., Apolone G., Bjorner J.B., Brazier J.E. et al. Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment. J. Clin. Epidemiol. 1998; 51(11): 1171-8. https://dx.doi.org/10.1016/s0895-4356(98)00109-7.
  29. Ashkenazi M.S., Huseby O.L., Kroken G., Trocha M., Henriksson A., Jasiak H. et al. The clinical presentation of endometriosis and its association to current surgical staging. J. Clin. Med. 2023; 12(7): 2688. https://dx.doi.org/10.3390/jcm12072688.
  30. Konrad L., Fruhmann Berger L.M., Maier V., Horné F., Neuheisel L.M., Laucks E.V. et al. Predictive model for the non-invasive diagnosis of endometriosis based on clinical parameters. J. Clin. Med. 2023; 12(13): 4231. https://dx.doi.org/10.3390/jcm12134231.
  31. Mechsner S., Kaiser A., Kopf A., Gericke C., Ebert A., Bartley J. A pilot study to evaluate the clinical relevance of endometriosis-associated nerve fibers in peritoneal endometriotic lesions. Fertil. Steril. 2009; 92(6): 1856-61. https://dx.doi.org/10.1016/j.fertnstert.2008.09.006.
  32. Kajitani T., Maruyama T., Asada H., Uchida H., Oda H., Uchida S. et al. Possible involvement of nerve growth factor in dysmenorrhea and dyspareunia associated with endometriosis. Endocr. J. 2013; 60(10): 1155-64. https://dx.doi.org/10.1507/endocrj.ej13-0027.
  33. Багирова У.А., Чернуха Е.Г., Филатова Е.Г. Особенности болевого синдрома при генитальном эндометриозе и мигрени. Неврология, нейропсихиатрия, психосоматика. 2021; 13(1): 31-7. [Bagirova U.A., Chernukha E.G., Filatova E.G. Features of pain syndrome in genital endometriosis and migraine. Neurology, Neuropsychiatry, Psychosomatics. 2021; 13(1): 31-7. (in Russian)]. https://dx.doi.org/10.14412/2074-2711-2021-1-31-37.
  34. Orr N.L., Huang A.J., Liu Y.D., Noga H., Bedaiwy M.A., Williams C. et al. Association of central sensitization inventory scores with pain outcomes after endometriosis surgery. JAMA Netw Open. 2023; 6(2): e230780. https://dx.doi.org/10.1001/jamanetworkopen.2023.0780.

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2. Fig. 1. Sample of patients included in the study

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3. Fig. 2. Frequency and structure of different forms of endometriosis in patients included in the study (n=200)

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4. Fig. 3. Tendency to increase the intensity of pain in patients with isolated EC and when combined with other forms of NGE

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5. Fig. 4. Determination of the threshold value of ITB in the diagnosis of GE

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