Illuminating Endometriosis-Related Pain: Novel Insights and Learnings from Existing Frameworks

Session Title: Illuminating Endometriosis-Related Pain: Novel Insights and Learnings from Existing Frameworks

Topic: CLINICAL SCIENCE

Description of Workshop: Pain is the most impactful and distressing symptom of endometriosis, experienced by up to 90% of those diagnosed. Endometriosis-related pain affects quality of life, mental health, healthcare utilisation and economic productivity. With an estimated 1 in 10 individuals assigned female at birth affected by endometriosis worldwide, the scale of this issue demands urgent attention. Despite its prevalence and burden, endometriosis-related pain remains poorly understood and inadequately managed. There is increasing recognition of the need to improve endometriosis-related pain management, and subsequent calls to action, across policy, research and clinical domains, globally. However, a lack of consensus regarding the biological and psychosocial mechanisms involved in endometriosis-related pain continues to obstruct the development of specific, effective interventions. This presents a major challenge for healthcare providers, researchers and policymakers seeking to implement equitable, scalable, and context-sensitive solutions. Addressing this gap is critical to reducing the personal and societal burden of endometriosis and improving outcomes for those affected.
Dr Lydia Coxon will discuss research on the mechanisms of pain in endometriosis, particularly similarities to other chronic pain conditions. She will discuss studies assessing the prevalence of neuropathic-like pain in endometriosis and findings using QST, highlighting the heterogeneity seen. She will also discuss nociplastic mechanisms which have growing research interest and evidence using questionnaires, sensory testing and brain imaging. She will present her work particularly from the IMI-PainCare TRiPP study reconceptualised chronic pelvic pain as a chronic pain condition and will highlight the complexity of understanding EAP and the possible role of multiple mechanisms.
Dr. Jan Wandrey will focus on endometriosis-related pain before and after surgery. He will present findings from the European NIT-1 study within the IMI-PainCare project, a large multi-centre observational study including 3,297 patients (of whom 860 had endometriosis) across 18 hospitals in Europe. The study investigates predictors of pain outcomes following surgery and factors influencing recovery and long-term symptom improvement. He will contextualize these findings within the broader framework of chronic post-surgical pain (CPSP), exploring similarities and differences between CPSP and endometriosis-related pain. He will outline how pre-operative factors predict post-surgical trajectories, and discuss how the CPSP conceptual framework may help explain the persistence of pain in a subset of individuals despite successful surgical excision. This presentation will provide novel insights into risk stratification and patient-centered management of post-surgical pain in endometriosis.
Brydee Pickup will present an innovative programme of research identifying psychosocial intervention targets for endometriosis-related pain management. Brydee will share findings from a large study (N = 872) establishing the role of interpretation bias in endometriosis-related pain interference and introducing the first biopsychosocial model of endometriosis-related pain. Additional findings from ecological momentary assessment and an RCT evaluating the efficacy of cognitive bias modification for interpretation, a highly scalable and accessible intervention, will also be presented. These findings will be discussed in relation to broader pain frameworks, including the widely accepted fear-avoidance model of chronic pain, to explore which concepts may be applicable and which aspects of endometriosis-related pain require unique consideration.

Speakers