Maddern Jessica, Grundy Luke, Castro Joel, Brierley Stuart M
Visceral Pain Research Group, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia.
Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
Front Cell Neurosci. 2020 Oct 6;14:590823. doi: 10.3389/fncel.2020.590823. eCollection 2020.
Endometriosis is a chronic and debilitating condition affecting ∼10% of women. Endometriosis is characterized by infertility and chronic pelvic pain, yet treatment options remain limited. In many respects this is related to an underlying lack of knowledge of the etiology and mechanisms contributing to endometriosis-induced pain. Whilst many studies focus on retrograde menstruation, and the formation and development of lesions in the pathogenesis of endometriosis, the mechanisms underlying the associated pain remain poorly described. Here we review the recent clinical and experimental evidence of the mechanisms contributing to chronic pain in endometriosis. This includes the roles of inflammation, neurogenic inflammation, neuroangiogenesis, peripheral sensitization and central sensitization. As endometriosis patients are also known to have co-morbidities such as irritable bowel syndrome and overactive bladder syndrome, we highlight how common nerve pathways innervating the colon, bladder and female reproductive tract can contribute to co-morbidity via cross-organ sensitization.
子宫内膜异位症是一种慢性衰弱性疾病，影响约10%的女性。子宫内膜异位症的特征是不孕和慢性盆腔疼痛，但治疗选择仍然有限。在许多方面，这与对导致子宫内膜异位症相关疼痛的病因和机制缺乏基本了解有关。虽然许多研究集中于逆行月经以及子宫内膜异位症发病机制中病变的形成和发展，但相关疼痛的潜在机制仍描述甚少。在此，我们综述了导致子宫内膜异位症慢性疼痛机制的最新临床和实验证据。这包括炎症、神经源性炎症、神经血管生成、外周敏化和中枢敏化的作用。由于已知子宫内膜异位症患者还伴有肠易激综合征和膀胱过度活动症等共病，我们强调支配结肠、膀胱和女性生殖道的常见神经通路如何通过跨器官敏化导致共病。
