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

Purpose: 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.

Methods: 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.

Results: 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).

Conclusions: 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.