Skip to main content

Advertisement

SpringerLink
Log in

Visual pain mapping in endometriosis

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To construct pain maps in order to describe the distribution of pelvic pain in a group of endometriosis patients and endometriosis-free patients, to assess the feasibility of this method.

Methods

A total of 159 patients with pelvic pain who were scheduled for diagnostic laparoscopy.

Results

A total of 117 patients with and 42 patients without endometriosis were included. The pain distribution between these two patient groups appeared to differ in some peripheral anatomical structures. In the endometriosis patients, the pain was most frequently located in the rectouterine pouch.

Conclusions

In endometriosis patients, pain mapping to assess preoperative pain sensations relative to the anatomic location of endometriotic lesions is feasible. The pain provoked by vaginal examination is frequently perceived as median relative to the actual anatomic location of the endometriotic lesions. Several anatomic and neurophysiological factors may explain this phenomenon.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Zimmermann A, Brandes I, Babitsch B (2010) Information needs of women with endometriosis within the scope of healthcare provision. Geburtsh Frauenheilk 70(7):568–573. doi:10.1055/s-0030-1250114

    Article  Google Scholar 

  2. Breidenbach M, Schmidt T, Volkmer A, Rath W, Fleisch MC, Maass N, Porn A, Hess A, Janni W, Rein DT (2011) Adenovirus-based targeted therapy for the treatment of endometriosis. Geburtsh Frauenheilk 71(1):59–66. doi:10.1055/s-0030-1250768

    Article  Google Scholar 

  3. Cramer DW, Missmer SA (2002) The epidemiology of endometriosis. Ann N Y Acad Sci 955:11–22 (discussion 34–36, 396–406)

    Article  PubMed  Google Scholar 

  4. Burghaus S, Klingsiek P, Fasching PA, Engel A, Haeberle L, Strissel PL, Schmidt M, Jonas K, Strehl JD, Hartmann A, Lermann J, Boosz A, Thiel F, Mueller A, Beckmann MW, Renner SP (2011) Risk factors for endometriosis in a German case–control study. Geburtsh Frauenheilk 71(12):1073–1079. doi:10.1055/s-0031-1280436

    Article  Google Scholar 

  5. Liu X, Guo SW (2008) Dysmenorrhea: risk factors in women with endometriosis. Womens Health (Lond Engl) 4(4):399–411. doi:10.2217/17455057.4.4.399

    Article  Google Scholar 

  6. Ballard K, Lane H, Hudelist G, Banerjee S, Wright J (2010) Can specific pain symptoms help in the diagnosis of endometriosis? A cohort study of women with chronic pelvic pain. Fertil Steril 94(1):20–27. doi:10.1016/j.fertnstert.2009.01.164

    Article  PubMed  Google Scholar 

  7. Fauconnier A, Fritel X, Chapron C (2009) Endometriosis and pelvic pain: epidemiological evidence of the relationship and implications. Gynecol Obstet Fertil 37(1):57–69. doi:10.1016/j.gyobfe.2008.08.016

    Article  PubMed  CAS  Google Scholar 

  8. Leng JH, Lang JH, Dai Y, Li HJ, Li XY (2007) Relationship between pain symptoms and clinico-pathological features of pelvic endometriosis. Zhonghua Fu Chan Ke Za Zhi 42(3):165–168

    PubMed  Google Scholar 

  9. Vercellini P, Fedele L, Aimi G, Pietropaolo G, Consonni D, Crosignani PG (2007) Association between endometriosis stage, lesion type, patient characteristics and severity of pelvic pain symptoms: a multivariate analysis of over 1000 patients. Hum Reprod 22(1):266–271. doi:10.1093/humrep/del339

    Article  PubMed  CAS  Google Scholar 

  10. Porpora MG, Koninckx PR, Piazze J, Natili M, Colagrande S, Cosmi EV (1999) Correlation between endometriosis and pelvic pain. J Am Assoc Gynecol Laparosc 6(4):429–434

    Article  PubMed  CAS  Google Scholar 

  11. Gardanis K, Zdichavsky M, Kramer M, Rothmund R, Juhasz-Bosz I, Fehm T, Zubke W, Wallwiener D, Solomayer EF (2010) Minimally invasive surgery for deep infiltrating endometriosis in the rectovaginal septum. Geburtsh Frauenheilk 70(3):194–200. doi:10.1055/s-0029-1240923

    Article  Google Scholar 

  12. Tripoli TM, Sato H, Sartori MG, de Araujo FF, Girao MJ, Schor E (2011) Evaluation of quality of life and sexual satisfaction in women suffering from chronic pelvic pain with or without endometriosis. J Sex Med 8(2):497–503. doi:10.1111/j.1743-6109.2010.01976.x

    Article  PubMed  Google Scholar 

  13. Seracchioli R, Mabrouk M, Guerrini M, Manuzzi L, Savelli L, Frasca C, Venturoli S (2008) Dyschezia and posterior deep infiltrating endometriosis: analysis of 360 cases. J Minim Invasive Gynecol 15(6):695–699. doi:10.1016/j.jmig.2008.07.005

    Article  PubMed  Google Scholar 

  14. Ballester M, Santulli P, Bazot M, Coutant C, Rouzier R, Darai E (2011) Preoperative evaluation of posterior deep-infiltrating endometriosis demonstrates a relationship with urinary dysfunction and parametrial involvement. J Minim Invasive Gynecol 18(1):36–42. doi:10.1016/j.jmig.2010.08.692

    Article  PubMed  Google Scholar 

  15. Renner SP, Rix S, Boosz A, Lermann JH, Strissel PL, Thiel FC, Oppelt P, Beckmann MW, Fasching PA (2010) Preoperative pain and recurrence risk in patients with peritoneal endometriosis. Gynecol Endocrinol 26(3):230–235. doi:10.1080/09513590903159623

    Article  PubMed  Google Scholar 

  16. He W, Liu X, Zhang Y, Guo SW (2010) Generalized hyperalgesia in women with endometriosis and its resolution following a successful surgery. Reprod Sci 17(12):1099–1111. doi:10.1177/1933719110381927

    Article  PubMed  Google Scholar 

  17. Howard FM (2009) Endometriosis and mechanisms of pelvic pain. J Minim Invasive Gynecol 16(5):540–550. doi:10.1016/j.jmig.2009.06.017

    Article  PubMed  Google Scholar 

  18. Mechsner S, Kaiser A, Kopf A, Gericke C, Ebert A, Bartley J (2009) A pilot study to evaluate the clinical relevance of endometriosis-associated nerve fibers in peritoneal endometriotic lesions. Fertil Steril 92(6):1856–1861. doi:10.1016/j.fertnstert.2008.09.006

    Article  PubMed  Google Scholar 

  19. Issa B, Onon TS, Agrawal A, Shekhar C, Morris J, Hamdy S, Whorwell PJ (2011) Visceral hypersensitivity in endometriosis: a new target for treatment? Gut. doi:10.1136/gutjnl-2011-300306

  20. Gerlinger C, Schumacher U, Faustmann T, Colligs A, Schmitz H, Seitz C (2010) Defining a minimal clinically important difference for endometriosis-associated pelvic pain measured on a visual analog scale: analyses of two placebo-controlled, randomized trials. Health Qual Life Outcomes 8:138. doi:10.1186/1477-7525-8-138

    Article  PubMed  Google Scholar 

  21. Deal LS, DiBenedetti DB, Williams VS, Fehnel SE (2010) The development and validation of the daily electronic endometriosis pain and bleeding diary. Health Qual Life Outcomes 8:64. doi:10.1186/1477-7525-8-64

    Article  PubMed  Google Scholar 

  22. Fabbri E, Villa G, Mabrouk M, Guerrini M, Montanari G, Paradisi R, Venturoli S, Seracchioli R (2009) McGill Pain Questionnaire: a multi-dimensional verbal scale assessing postoperative changes in pain symptoms associated with severe endometriosis. J Obstet Gynaecol Res 35(4):753–760. doi:10.1111/j.1447-0756.2008.00994.x

    Article  PubMed  Google Scholar 

  23. Schott GD (2010) The cartography of pain: the evolving contribution of pain maps. Eur J Pain 14(8):784–791. doi:10.1016/j.ejpain.2009.12.005

    Article  PubMed  Google Scholar 

  24. Turp JC, Kowalski CJ, O’Leary N, Stohler CS (1998) Pain maps from facial pain patients indicate a broad pain geography. J Dent Res 77(6):1465–1472

    Article  PubMed  CAS  Google Scholar 

  25. Jud SM, Fasching PA, Maihofner C, Heusinger K, Loehberg CR, Hatko R, Rauh C, Bani H, Lux MP, Beckmann MW, Bani MR (2010) Pain perception and detailed visual pain mapping in breast cancer survivors. Breast Cancer Res Treat 119(1):105–110. doi:10.1007/s10549-009-0485-z

    Article  PubMed  Google Scholar 

  26. Mechsner S, Infanger M, Ebert AD, Schneider A, Bartley J (2010) Abdominal wall endometriosis—diagnosis and therapeutic management. Geburtsh Frauenheilk 70(3):207–214. doi:10.1055/s-0029-1240924

    Article  Google Scholar 

  27. Wolfler MM, Stadermann M, Rath W, Klein P, Maass N, Rimbach S (2011) Diagnostic screening in symptomatic patients with and without endometriosis. Geburtsh Frauenheilk 71(1):53–58. doi:10.1055/s-0030-1250677

    Article  Google Scholar 

  28. Vercellini P, Trespidi L, De Giorgi O, Cortesi I, Parazzini F, Crosignani PG (1996) Endometriosis and pelvic pain: relation to disease stage and localization. Fertil Steril 65(2):299–304

    PubMed  CAS  Google Scholar 

  29. Kelm Junior AR, Lancellotti CL, Donadio N, Auge AP, Lima SM, Aoki T, Ribeiro PA (2008) Nerve fibers in uterosacral ligaments of women with deep infiltrating endometriosis. J Reprod Immunol 79(1):93–99. doi:10.1016/j.jri.2008.08.004

    Article  PubMed  Google Scholar 

  30. Benjamin-Pratt AR, Howard FM (2010) Management of chronic pelvic pain. Minerva Ginecol 62(5):447–465

    PubMed  CAS  Google Scholar 

  31. Zupi E, Sbracia M, Marconi D, Zullo F, Santi K, Solima E, Romanini C (1999) Pain mapping during minilaparoscopy in infertile patients without pathology. J Am Assoc Gynecol Laparosc 6(1):51–54

    Article  PubMed  CAS  Google Scholar 

  32. Teepker M, Peters M, Vedder H, Schepelmann K, Lautenbacher S (2010) Menstrual variation in experimental pain: correlation with gonadal hormones. Neuropsychobiology 61(3):131–140. doi:10.1159/000279303

    Article  PubMed  CAS  Google Scholar 

  33. Coulombe MA, Spooner MF, Gaumond I, Carrier JC, Marchand S (2011) Estrogen receptors beta and alpha have specific pro- and anti-nociceptive actions. Neuroscience 184:172–182. doi:10.1016/j.neuroscience.2011.02.057

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

All authors have no financial and personal relationships with other people or organisations that could inappropriately influence this work.

Author information

Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany

    Stefan P. Renner, Alexander S. Boosz, Stefanie Burghaus, Matthias W. Beckmann, Peter A. Fasching & Sebastian M. Jud

  2. Department of Neurology, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany

    Christian Maihöfner

Authors
  1. Stefan P. Renner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexander S. Boosz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stefanie Burghaus
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christian Maihöfner
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Matthias W. Beckmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Peter A. Fasching
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sebastian M. Jud
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stefan P. Renner.

Additional information

S. P. Renner and A. S. Boosz contributed equally to this study.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Renner, S.P., Boosz, A.S., Burghaus, S. et al. Visual pain mapping in endometriosis. Arch Gynecol Obstet 286, 687–693 (2012). https://doi.org/10.1007/s00404-012-2369-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-012-2369-4

Keywords

Search

Navigation