Endometriosis Pain Management: a Review
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OTHER PAIN (N VADIVELU AND AD KAYE, SECTION EDITORS)
Endometriosis Pain Management: a Review Daniel Carlyle 1 & Tarek Khader 2 & David Lam 1 & Nalini Vadivelu 1 & Devina Shiwlochan 1 & Cho Yonghee 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review The purpose of this review is to summarize the up-to-date pain management options and recommendations for the challenging disease, endometriosis. Recent Findings The mainstays of endometriosis advances of both surgical and medical management continue to evolve. Experimental pharmaceuticals include Gestirone, and aromatase inhibitors have shown promise but are still under scrutiny. Surgical techniques include laparoscopic uterosacral nerve ablation/resection and presacral neurectomy. Summary No studies have directly compared medical versus surgical management, and as such, no one treatment modality can be recommend as superior to the other. Patients may initially be given a medical diagnosis and treated with nonsteroidal antiinflammatory drugs, neurolepitcs, OCP, GNRH agonists/antagonists, and Danazol. Assessing the success of these regimens has proved difficult. Surgical management relies on various methods including excision/ablation of the lesions, nerve ablation, neurectomy, hysterectomy, and oophorectomy. Keywords Endometriosis . Endometriosis pain management . Surgical management endometriosis . Medical management endometriosis . Endometriosis adjuvants . Endometriosis experimental treatments
Introduction Endometriosis is defined as the presence of endometrial glands and stroma in an abnormal or ectopic location outside the uterine cavity. The most common locations are primarily the pelvic peritoneum, ovaries, and rectovaginal septum [1]. The disease is most commonly found in adolescent and reproductive aged women with associated symptoms of chronic pelvic pain and infertility [2]. The aberrant endometrial-like tissue responds to hormonal stimulation, undergoing cyclical growth, and shedding similar to appropriately located endometrial tissue. Like eutopic endometrial tissue, endometriosis lesions contain endometrial glands and stroma. However, This article is part of the Topical Collection on Other Pain * Daniel Carlyle [email protected] 1
Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street, TMP 3, P.O. Box 208051, New Haven, CT 06510, USA
2
Department of Obstetrics and Gynecology, Yale University School of Medicine, 333 Cedar Street, TMP 3, P.O. Box 208051, New Haven, CT 06510, USA
unlike eutopic endometrium, endometriosis implants often contain fibrous tissue, blood, and cysts. Endometriosis occurs in approximately 6–10% of reproductive aged women and is present in 20–50% in women with infertility and 71–87% in women with chronic pelvic pain. [3–9]
Theories of Endometriosis Pathogenesis While several theories on the development of endometriosis have been proposed, the etiology of this disease process is still a subject of debate. The most common theories are Sampson’s theo
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