Moreira Marcelo de França, Oliveira Marco Aurelio Pinho
Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Department of Gynecology, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
BJOG. 2025 May;132(6):685-693. doi: 10.1111/1471-0528.18096. Epub 2025 Feb 5.
Endometriosis pain is mainly understood based on peripheral lesion characteristics and an outdated perspective equating nociception with pain. This limited view may divert understanding of interventions beyond peripheral logic, leading clinicians to see approaches targeting other processes as supplementary, limiting the effective addressing of treatment failure. Integrating critical advancements in pain and endometriosis can promote more comprehensive knowledge.
This article provides a conceptual framework focusing on overlooked or less clearly linked areas concerning the interplay between nociception and factors influencing endometriosis pain. It explores the complexity of nociceptive processing, the association between neuromerically connected structures, and the role of the brain in pain perception. Further, it emphasizes adopting mechanism-based understanding of pain that integrates neurobiological aspects of the nociceptive apparatus and related systems, shaped by psychosocial factors contributing to a possible negative spiral in those living with endometriosis.
Aware of such a broader perspective can incentivize a balanced effort to inquire into peripheral lesion-related mechanisms and other domains potentially impacting endometriosis pain.
子宫内膜异位症疼痛主要是基于外周病变特征以及将伤害感受等同于疼痛的过时观点来理解的。这种有限的观点可能会转移对超出外周逻辑的干预措施的理解，导致临床医生将针对其他过程的方法视为辅助手段，限制了对治疗失败的有效应对。整合疼痛和子宫内膜异位症方面的关键进展可以促进更全面的认识。
本文提供了一个概念框架，重点关注伤害感受与影响子宫内膜异位症疼痛的因素之间相互作用中被忽视或联系不那么紧密的领域。它探讨了伤害性处理的复杂性、神经节段连接结构之间的关联以及大脑在疼痛感知中的作用。此外，它强调采用基于机制的疼痛理解，这种理解整合了伤害性感受器装置和相关系统的神经生物学方面，这些方面受到社会心理因素的影响，可能导致子宫内膜异位症患者出现负面螺旋式下降。
认识到这样一个更广阔的视角可以促使人们在探究与外周病变相关的机制以及其他可能影响子宫内膜异位症疼痛的领域时做出平衡的努力。
