Neuropathic-like pain affects pain perception in patients with deep endometriosis: an observational study

Endometriosis is a chronic, hormone-dependent disease affecting up to 10% of women of reproductive age, often associated with chronic pelvic pain (CPP). Neuropathic pain has been increasingly recognized as a significant component in a subset of patients with CPP related to endometriosis. The study objective was to assess the prevalence of neuropathic-like pain in women with deep endometriosis (DE) and CPP, and to analyze its influence on pain perception and quality of life.

Retrospective monocentric cohort study included 149 women with DE and CPP treated at a tertiary pain center between 2013 and 2017. Pain characteristics were assessed using validated tools, including the DN4 questionnaire for neuropathic pain, the abridged Saint-Antoine Pain Questionnaire (QDSA) for sensory and emotional dimensions of pain, and the EQ-VAS for quality of life. Psychological factors, including anxiety, depression, and catastrophizing, were also evaluated.

Neuropathic-like pain was identified in 36% of patients. These patients reported significantly higher global and minimum pain intensity (p < 0.01, p < 0.01), greater emotional (QDSA affective subscore, p < 0.05) and sensory (QDSA sensory subscore, p < 0.001) pain impact, and higher catastrophizing scores (p < 0.001). Quality of life was notably impaired (p < 0.05). Neuropathic-like pain was not associated with the stage of endometriosis or surgical complexity. Anxiety and depression scores did not differ significantly between the two groups (p = 0.47 and p = 0.52, respectively).

Neuropathic-like pain was retrieved in over one-third of patients with DE and CPP, contributing to greater pain intensity, emotional distress, and reduced quality of life. Systematic screening for neuropathic-like pain and tailored multidisciplinary care are essential to optimize pain management.