ORIGINAL PAPER
Central sensitisation as a mechanism of chronic pain in women with endometriosis – a systematic review of the literature
1
Department of Coordinated Maternity Care, Medical University of Lublin, Poland
2
Chair of Obstetrics and Gynaecology, Department Obstetric and Gynaecological Nursing, Faculty of Health Sciences, Medical University of Lublin, Poland
These authors had equal contribution to this work
Submission date: 2026-03-03
Acceptance date: 2026-04-03
Online publication date: 2026-07-15
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Endometriosis in women is a chronic inflammatory disease in which pain is the dominant and often the most debilitating clinical symptom. The severity of pain often does not correlate with the extent of anatomical changes, and in a significant proportion of patients it persists despite surgical and hormonal treatment.
Aim of the research:
To analyse the available scientific evidence on central sensitisation as a mechanism of chronic pain in women with endometriosis, taking into account its relationship with neuropathic pain, nociceptive pain, myofascial pain, and quality of life after surgical treatment.
Material and methods:
The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. In November and December 2025, electronic databases, including PubMed, Scopus, and Web of Science, were searched. The search strategy was based on the keywords “endometriosis”, “central nervous system sensitisation”, and “central sensitisation”. Ultimately, 14 publications were included in the review.
Results:
The findings clearly indicate a frequent occurrence of central sensitisation, reduced pain thresholds, and symptoms of neuropathic pain in women with endometriosis. They also suggest strong links between these mechanisms and pain intensity, sexual dysfunction, anxiety and depressive disorders, and poorer quality of life, including in women who have undergone surgical treatment.
Conclusions:
Central sensitisation appears to be a major mechanism underlying chronic pain in women with endometriosis. Failure to take it into account in the therapeutic process may lead to the ineffectiveness of surgical and pharmacological treatment.
Endometriosis in women is a chronic inflammatory disease in which pain is the dominant and often the most debilitating clinical symptom. The severity of pain often does not correlate with the extent of anatomical changes, and in a significant proportion of patients it persists despite surgical and hormonal treatment.
Aim of the research:
To analyse the available scientific evidence on central sensitisation as a mechanism of chronic pain in women with endometriosis, taking into account its relationship with neuropathic pain, nociceptive pain, myofascial pain, and quality of life after surgical treatment.
Material and methods:
The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. In November and December 2025, electronic databases, including PubMed, Scopus, and Web of Science, were searched. The search strategy was based on the keywords “endometriosis”, “central nervous system sensitisation”, and “central sensitisation”. Ultimately, 14 publications were included in the review.
Results:
The findings clearly indicate a frequent occurrence of central sensitisation, reduced pain thresholds, and symptoms of neuropathic pain in women with endometriosis. They also suggest strong links between these mechanisms and pain intensity, sexual dysfunction, anxiety and depressive disorders, and poorer quality of life, including in women who have undergone surgical treatment.
Conclusions:
Central sensitisation appears to be a major mechanism underlying chronic pain in women with endometriosis. Failure to take it into account in the therapeutic process may lead to the ineffectiveness of surgical and pharmacological treatment.
REFERENCES (24)
1.
Orr NL, Huang AJ, Liu YD, Noga H, Bedaiwy MA, Williams C, Allaire C, Yong PJ. Association of central sensitization inventory scores with pain outcomes after endometriosis surgery. JAMA Netw Open. 2023; 6(2): e230780.
2.
Van Aken M, Oosterman J, Van Rijn T, Woudsma K, Ferdek M, Ruigt G, Kozicz T, Braat D, Peeters A, Nap A. Experimental pain tolerance is decreased and independent of clinical pain intensity in patients with endometriosis. Fertil Steril. 2018; 110(6): 1118-1128.
3.
Ding A, Noga H, Bouchard KN, Bedaiwy MA, Lee C, Allaire C, Orr NL, Yong PJ. Pain with orgasm in endometriosis: potential etiologic factors and clinical correlates. J Sex Med. 2024; 21(9): 807-815.
4.
Tucker DR, Noga HL, Lee C, Chiu DS, Bedaiwy MA, Williams C, Allaire C, Talhouk A, Yong PJ. Pelvic pain comorbidities associated with quality of life after endometriosis surgery. Am J Obstet Gynecol. 2023; 229(2): 147.e1-147.e20.
5.
Gentles A, Goodwin E, Bedaiwy Y, Marshall N, Yong PJ. Nociplastic pain in endometriosis: a scoping review. J Clin Med. 2024; 13(24): 7521.
6.
Dolci C, Jean Dit Gautier E, Lannez L, Lebuffe G, Wat- tier JM, Rubod C. Neuropathic-like pain affects pain perception in patients with deep endometriosis: an observational study. Arch Gynecol Obstet. 2025; 312(5): 1789-1797.
7.
Koninckx PR, Meuleman C, Demeyere S, Lesaffre E, Cornillie FJ. Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain. Fertil Steril. 1991; 55(4): 759-765.
8.
Bedaiwy MA, Alfaraj S, Yong P, Casper R. New developments in the medical treatment of endometriosis. Fertil Steril. 2017; 107(3): 555-565.
9.
Shakiba K, Bena JF, McGill KM, Minger J, Falcone T. Surgical treatment of endometriosis: a 7-year follow-up on the requirement for further surgery. Obstet Gynecol. 2008; 111(6): 1285-1292.
10.
Quintas-Marquès L, Martínez-Zamora MÁ, Camacho M, Gràcia M, Rius M, Ros C, Carrion A, Carmona F. Central sensitization in patients with deep endometriosis. Pain Med. 2023; 24(8): 1005-1007.
11.
Bouko-Levy E, Auditeau E, Margueritte F, Lacorre A, Gauthier T. Prevalence of neuropathic pain in patients with symptomatic endometriosis: assessment using the DN4 score. Eur J Obstet Gynecol Reprod Biol. 2024; 300: 196-201.
12.
Yong PJ, Williams C, Bedaiwy MA, Allaire C. A proposed platform for phenotyping endometriosis-associated pain: unifying peripheral and central pain mechanisms. Curr Obstet Gynecol Rep. 2020; 9(3): 89-97.
13.
Cetera GE, Merli CEM, Boero V, Caia C, Facchin F, Barba- ra G, Monti E, Vercellini P. Central sensitization in vulvodynia and endometriosis: what have we been overlooking so far? Obstet Gynecol Surv. 2023; 78(12): 745-758.
14.
Orr NL, Wahl KJ, Noga H, Allaire C, Williams C, Bedaiwy MA, Albert A, Smith KB, Yong PJ. Phenotyping sexual pain in endometriosis using the central sensitization inventory. J Sex Med. 2020; 17(4): 761-770.
15.
Stratton P, Khachikyan I, Sinaii N, Ortiz R, Shah J. Association of chronic pelvic pain and endometriosis with signs of sensitization and myofascial pain. Obstet Gynecol. 2015; 125(3): 719-728.
16.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372: n71.
17.
Quintas-Marquès L, Valdés-Bango M, Box C, Gràcia M, Rius M, Carmona F, Martinez-Zamora MA. Multidimensional evaluation of myofascial pelvic pain and other comorbidities in endometriosis patients. J Clin Med. 2025; 14(10): 3455.
18.
Nijs J, Lahousse A, Kapreli E, Bilika P, Saraçoğlu İ, Malfliet A, Coppieters I, De Baets L, Leysen L, Roose E, Clark J, Voogt L, Huysmans E. Nociplastic pain criteria or recognition of central sensitization? Pain phenotyping in the past, present and future. J Clin Med. 2021; 10(15): 3203.
19.
Grundström H, Gerdle B, Alehagen S, Berterö C, Arendt- Nielsen L, Kjølhede P. Reduced pain thresholds and signs of sensitization in women with persistent pelvic pain and suspected endometriosis. Acta Obstet Gynecol Scand. 2019; 98(3): 327-336.
20.
Ping Z, Wen Z, Jinhua L, Jinghe L. Research on central sensitization of endometriosis-associated pain: a systematic review of the literature. J Pain Res. 2019; 12: 1447-1456.
21.
Alves JS, Meneses T, Mariano M, Serra SS, Costa T, Mar- tins JP, Rabishong B, Lima J. Is endometriosis staging related to the type and intensity of patients’ complaints? A systematic review and meta-analysis. J Minim Invasive Gynecol. 2026; 33(5): 505-515.
22.
McNamara HC, Frawley HC, Donoghue JF, Readman E, Healey M, Ellett L, Reddington C, Hicks LJ, Harlow K, Rogers PAW, Cheng C. Peripheral, central, and cross sensitization in endometriosis-associated pain and comorbid pain syndromes. Front Reprod Health. 2021; 3: 729642.
23.
Orr NL, Wahl KJ, Lisonek M, Joannou A, Noga H, Albert A, Bedaiwy MA, Williams C, Allaire C, Yong PJ. Central sensitization inventory in endometriosis. Pain. 2022; 163(2): e234-e245.
24.
Yosef A, Allaire C, Williams C, Ahmed AG, Al-Hussaini T, Abdellah MS, Wong F, Lisonkova S, Yong PJ. Multifactorial contributors to the severity of chronic pelvic pain in women. Am J Obstet Gynecol. 2016; 215(6): 760.e1-760.e14.
| eISSN: | 2300-6722 |
| ISSN: | 1899-1874 |
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