Central Sensitization and Hormonal Therapy Failure for Endometriosis-Related Pain Symptoms: A Prospective Study
Diego Raimondo1, Linda Bertoldo2, Alberto Aguzzi2
1Division of Gynecology and Human Reproduction Physiopathology (Drs. Raimondo, Bertoldo, Aguzzi, Ramelli, Maletta, Doglioli, Seracchioli), IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Objective:
To investigate the association between central sensitization inventory (CSI) scores/central sensitization (CS) and hormonal therapy failure (HTF) for endometriosis.
Design:
Single-center, observational, prospective, cohort study.
Setting:
Tertiary-level referral center for endometriosis.
Participants:
A total of 114 consecutive symptomatic patients with endometriosis without previous hormonal therapy or with at least 3 months washout, referring to our center from January 10, 2024, to April 30, 2024.
Interventions:
At baseline (T0), endometriosis-associated pain symptoms were assessed using numeric rating scale (NRS), CSI questionnaire was completed, and hormonal therapy for endometriosis was prescribed. At 6-month follow-up (T1), pain symptoms were reassessed using NRS. HTF was defined as a reduction of less than 30% in the NRS score for the specific pain symptom between T0 and T1. Study outcomes were the association of CSI scores (as a continuous variable) or CS (defined by CSI score ≥40) with HTF for chronic pelvic pain (CPP), dysmenorrhea, deep dyspareunia, dyschezia, and dysuria. Associations were assessed using univariable and multivariable logistic regression models, reporting odds ratios (OR) with 95% confidence intervals and considering p < .05 as significant.
Results:
The mean CSI score was 35.87, and 46 patients (40.4%) had CS. Both higher baseline CSI scores and presence of CS were significantly associated with HTF for CPP, deep dyspareunia and dyschezia, at both univariable (OR of 1.046, 1.047 and 1.062; and OR of 2.778, 4.425 and 3.922, respectively) and multivariable analyses (OR of 1.057, 1.052 and 1.075; and OR of 3.058, 4.098 and 4.545, respectively). Dysmenorrhea and dysuria were not considered in the analysis, since only 7.0% of patients received cyclic hormonal therapy, and only 5.3% reported dysuria at T0.
Conclusion:
In women with endometriosis treated with hormonal therapy, both higher pretreatment CSI scores and presence of CS were independently associated with HTF for CPP, deep dyspareunia, and dyschezia.
