Volume 1 Issue 2 - 2015
Endometriosis-Related Pain, the Forgotten
Fundación IVI, Instituto Universitario IVI/INCLIVA, Valencia, Spain
*Corresponding Author: Garcia-Pascual, Fundación IVI, Instituto Universitario IVI/INCLIVA, Valencia, Spain.
Received: November 26, 2014; Published: March 18, 2015
Citation: Garcia-Pascual. “Endometriosis-Related Pain, the Forgotten”. EC Gynaecology 1.2 (2015): 44-45.
Endometriosis is an estrogen dependent disease defined by growths of uterine tissue at ectopic places. More than 15% of women of reproductive age suffer from this disease and up to 50% of women suffer from vaginal hyperalgesia and pelvic pain [1]. Evidence from both human and animal studies suggest that abnormal immune, vascular and neural activities in the ectopic endometrium contribute to inflammatory signs and symptoms associated with endometriosis [2]. Nevertheless, mechanisms are poorly understood because most investigators and clinicians agree that the growths do not predict pain symptoms. Standard treatments often fail to provide long-term relief. Pain can be diminished by removing peritoneal implants, nodules and ovarian cysts. Another strategy is to induce lesion suppression by eliminating ovulation and menstruation through hormonal manipulation with progestins, oral contraceptive and gonadotropin-releasing hormone agonists [3]. The main problem is that medical therapy is symptomatic and surgery is associated with high recurrence rates. In spite of it is known that nerve fibers are present in ovarian endometrioses in higher density than normal ovarian cortex from women with ovarian endometriosis [4,5], the research of novel treatments has only focused on the antiangiogenic strategy [6,7], but the relation between antiangiogenic treatments and vaginal hyperalgesia has been totally forgotten. This fact is really surprising due to the percentage of women that develop chronic pelvic pain, vaginal hyperalgesia (dyspareunia), dysmenorrhea (excessive menstrual pain), dyspareunia (vaginal hyperalgesia), and dyschezia (pain with defecation), which can co-occur with a range of other painful conditions [8]. Symptoms can range from moderate to severe [2] and could have a high impact in the life of such patients, leading to serious problems like depression [9]. Nevertheless, it seems that the study of pain in endometriosis is starting to be seriously considered. One of the reoccurring problems is the fact that the study of pain is really difficult and is it is also hard to establish an animal model of endometriosis which allows for the study of pain. In this regard, the group of Dr. Berkley and Dr. Dmitrieva has developed a rat model of vaginal hyperalgesia [10,11] which allows the study of novel drugs in the hyperalgesia related to endometriosis. In such model, endometriosis is surgically-induced. To achieve this, fragments of uterus from the same rat are sewn around the mesenteric arteries. Similar to women, animals develop cysts in the abdomen [12] and these cysts attract their own nerve and blood supply [5,11]. Importantly, like in women, the establishment of the cysts causes the animals, both vaginal hyperalgesia [13] and vaginally-referred abdominal muscle hyperalgesia. In previous studies, vaginal hyperalgesia in rats has been assessed either with a behavioral test [13] or with a technique that measures abdominal muscle electrical activity in response to vaginal distention. This later measured, which refers to abdominal muscle response to noxious stimuli, which is called visceromotor response (VMR). These techniques have been successfully used to reveal estrous differences in pelvic nociception and the effects of drugs and surgical manipulations [13,14]. Nevertheless, these techniques are labor-intensive and cumbersome to use for drug testing. Due to these limitations Dmitrieva and col developed a new technique that combined VMR with vaginal distention and telemetric methodology [2]. validating its applicability in two experimental settings. This model consists in the implantation of a telemetric probe (Data Sciences International, DSI, MN, USA), which allows the study of the vaginal hyperalgesia in awaken rats. So, this model is suitable to study the effects of new drugs in endometriosis-related vaginal hyperalgesia. Unfortunately, it is not widely known. In my opinion we should focus on this model and more groups should work with it to improve it. Endometriosis-related pain is a fact, a fact that an important number of women suffer from every day. We have the tools to make the difference, why should not we try?
  1. Giudice LC. “Clinical practice. Endometriosis”. The New England Journal of Medicine 362.25 (2010): 2389-2398.
  2. Dmitrieva N., et al. “Resolvins RvD1 and 17(R)-RvD1 alleviate signs of inflammation in a rat model of endometriosis”. Fertility and Sterility 102.4 (2014): 1191-1196.
  3. Vercellini P., et al. “Endometriosis: pathogenesis and treatment”. Nature Reviews. Endocrinology 10.5 (2014): 261-275.
  4. Tokushige N., et al. “Nerve fibres in peritoneal endometriosis”. Human Reproduction 21.11 (2006): 3001-3007.
  5. Zhang X., et al. “Innervation of endometrium and myometrium in women with painful adenomyosis and uterine fibroids”. Fertility and Sterility 94.2 (2010): 730-737.
  6. Delgado-Rosas F., et al. “The effects of ergot and non-ergot-derived dopamine agonists in an experimental mouse model of endometriosis”. Reproduction142.5 (2011): 745-55.
  7. Novella-Maestre E., et al. “Effect of antiangiogenic treatment on peritoneal endometriosis-associated nerve fibers”. Fertility and Sterility98.5 (2012): 1209-1217.
  8. Stratton P and Berkley KJ. “Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications”. Human Reproduction Update 17.3 (2011): 327-346.
  9. Lorencatto C., et al. “Depression in women with endometriosis with and without chronic pelvic pain”. Acta Obstetricia et Gynecologica Scandnavica 85.1 (2006): 88-92.
  10. Dmitrieva N., et al. “Telemetric assessment of referred vaginal hyperalgesia and the effect of indomethacin in a rat model of endometriosis”. Frontiers in Pharmacology 3 (2012): 158.
  11. McAllister SL., et al. “Sprouted innervation into uterine transplants contributes to the development of hyperalgesia in a rat model of endometriosis”. PLoS One7.2 (2012): e31758.
  12. Vernon MW and Wilson EA. “Studies on the surgical induction of endometriosis in the rat”. Fertility and Sterility 44.5 (1985): 684-694.
  13. Cason AM., et al. “Estrous changes in vaginal nociception in a rat model of endometriosis”. Hormones and Behavior 44.2 (2003): 123-131.
  14. Dmitrieva N., et al. “Endocannabinoid involvement in endometriosis”. Pain151.3 (2010): 703-710.
Copyright: © 2015 Garcia-Pascual. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

March Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the March issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

ECronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before April 03, 2023.

Certificate of Publication

ECronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

ECronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.