Materiały źródłowe

• #1 Chronic Pelvic Pain – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554585/

  Chronic pelvic pain is a persistent or recurrent pain in the lower abdomen or pelvis lasting at least 3 to 6 months. […] The clinical heterogeneity of chronic pelvic pain and its incompletely understood pathogenesis make treatment challenging. […] The pathophysiology of chronic pelvic pain is thought to involve centralized pain mechanisms. Patients with chronic pelvic pain often develop hyperesthesia and allodynia, which are frequently exacerbated by pelvic floor dysfunction. […] Chronic pelvic pain is often secondary to comorbid conditions that cause chronic pain. […] The prolonged nature of this pain increases the risk of central sensitization, contributing to the development of chronic pelvic pain. […] As comorbidities accumulate, the persistence of symptoms promotes central sensitization, further intensifying pain perception.

• #2 UNIFIND – UNIMI – Chronic pelvic pain in women : etiology, pathogenesis and diagnostic approach

  https://expertise.unimi.it/resource/item/96129

  Chronic pelvic pain (CPP), defined as non-cyclic pain of 6 or more months, is a frequent disorder that may negatively affect health-related quality of life. […] Different neurophysiological mechanisms are involved in the pathophysiology of CPP. Pain may be classified as nociceptive or non-nociceptive. In the first case the symptom originates from stimulation of a pain-sensitive structure, whereas in the second pain is considered neuropatic or psychogenic. […] Many disorders of the reproductive tract, urological organs, gastrointestinal, musculoskeletal and psycho-neurological systems may be associated with CPP. Excluding endometriosis, the most frequent causes of CPP are: post-operative adhesions, pelvic varices, interstitial cystitis and irritable bowel syndrome. CPP is a symptom, not a disease, and rarely reflects a single pathologic process.

• #3 UNIFIND – UNIMI – Chronic pelvic pain in women : etiology, pathogenesis and diagnostic approach

  https://expertise.unimi.it/resource/item/96129

  Chronic pelvic pain (CPP), defined as non-cyclic pain of 6 or more months, is a frequent disorder that may negatively affect health-related quality of life. […] Different neurophysiological mechanisms are involved in the pathophysiology of CPP. Pain may be classified as nociceptive or non-nociceptive. In the first case the symptom originates from stimulation of a pain-sensitive structure, whereas in the second pain is considered neuropatic or psychogenic. […] Many disorders of the reproductive tract, urological organs, gastrointestinal, musculoskeletal and psycho-neurological systems may be associated with CPP. Excluding endometriosis, the most frequent causes of CPP are: post-operative adhesions, pelvic varices, interstitial cystitis and irritable bowel syndrome. CPP is a symptom, not a disease, and rarely reflects a single pathologic process.

• #4 UNIFIND – UNIMI – Chronic pelvic pain in women : etiology, pathogenesis and diagnostic approach

  https://expertise.unimi.it/resource/item/96129

  Chronic pelvic pain (CPP), defined as non-cyclic pain of 6 or more months, is a frequent disorder that may negatively affect health-related quality of life. […] Different neurophysiological mechanisms are involved in the pathophysiology of CPP. Pain may be classified as nociceptive or non-nociceptive. In the first case the symptom originates from stimulation of a pain-sensitive structure, whereas in the second pain is considered neuropatic or psychogenic. […] Many disorders of the reproductive tract, urological organs, gastrointestinal, musculoskeletal and psycho-neurological systems may be associated with CPP. Excluding endometriosis, the most frequent causes of CPP are: post-operative adhesions, pelvic varices, interstitial cystitis and irritable bowel syndrome. CPP is a symptom, not a disease, and rarely reflects a single pathologic process.

• #5 UNIFIND – UNIMI – Chronic pelvic pain in women : etiology, pathogenesis and diagnostic approach

  https://expertise.unimi.it/resource/item/96129

  Chronic pelvic pain (CPP), defined as non-cyclic pain of 6 or more months, is a frequent disorder that may negatively affect health-related quality of life. […] Different neurophysiological mechanisms are involved in the pathophysiology of CPP. Pain may be classified as nociceptive or non-nociceptive. In the first case the symptom originates from stimulation of a pain-sensitive structure, whereas in the second pain is considered neuropatic or psychogenic. […] Many disorders of the reproductive tract, urological organs, gastrointestinal, musculoskeletal and psycho-neurological systems may be associated with CPP. Excluding endometriosis, the most frequent causes of CPP are: post-operative adhesions, pelvic varices, interstitial cystitis and irritable bowel syndrome. CPP is a symptom, not a disease, and rarely reflects a single pathologic process.

• #6 EAU Guidelines on Chronic Pelvic Pain – Uroweb

  https://uroweb.org/guidelines/chronic-pelvic-pain/chapter/epidemiology-aetiology-and-pathophysiology

  Over the years much of the focus for CPPPS has been on peripheral-end-organ mechanisms, such as inflammatory or infective conditions. However, both animal and clinical research have indicated that many of the mechanisms for the CPPPSs are based within the CNS. […] Although ongoing peripheral organ pathology can produce persistent and chronic pain, the main focus of these guidelines is on CPPPSs in which no peripheral ongoing pathology (such as infection or neoplastic disease) is detected. The main exception is when pain is due to peripheral nerve damage. […] Risk factors include many different factors from various areas, including genetic, psychological state, recurrent physical trauma and endocrine factors. […] Studies about integrating the psychological factors of CPPPSs are few but the quality is high. Psychological factors are consistently found to be relevant in the maintenance of persistent pelvic and urogenital pain. […] The various mechanisms of CNS facilitation, amplification and failure of inhibition mean that there is no simple relationship between physical findings, pain experience and resulting distress and restriction of activities.

• #7 Chronic Pelvic Pain – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554585/

  The pathophysiology of chronic pelvic pain varies depending on the underlying condition. In endometriosis, cyclical pain arises from recurrent bleeding of ectopic endometrial implants, leading to inflammation and neurogenic sensitization. […] However, the majority of chronic pelvic pain cases are driven by central sensitization, a process in which persistent pain alters the nervous system, heightening sensitivity and amplifying discomfort, even after the original pathology has resolved.

• #8 Chronic Pelvic Pain | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26872

  Chronic pelvic pain is a form of centralized pain, where the body develops a lower threshold for discomfort or uncomfortable sensations, often as a result of chronic pain. For example, in women with endometriosis, the acute pain associated with the condition can become centralized over a 3- to 6-month period, evolving into chronic pain. […] The pathophysiology of chronic pelvic pain is thought to involve centralized pain mechanisms. Patients with chronic pelvic pain often develop hyperesthesia and allodynia, which are frequently exacerbated by pelvic floor dysfunction. […] Chronic pelvic pain is often secondary to comorbid conditions that cause chronic pain. A synergistic effect can occur when dysfunction in an organ system leads to issues in another. […] The pathophysiology of chronic pelvic pain varies depending on the underlying condition. In endometriosis, cyclical pain arises from recurrent bleeding of ectopic endometrial implants, leading to inflammation and neurogenic sensitization. In pelvic congestion syndrome, dilated and engorged pelvic veins produce mechanical and ischemic pain. However, the majority of chronic pelvic pain cases are driven by central sensitization, a process in which persistent pain alters the nervous system, heightening sensitivity and amplifying discomfort, even after the original pathology has resolved.

• #9 EAU Guidelines on Chronic Pelvic Pain – Uroweb

  https://uroweb.org/guidelines/chronic-pelvic-pain/chapter/epidemiology-aetiology-and-pathophysiology

  The mechanisms that serve as an underlying cause for chronic pelvic pain are: ongoing acute pain mechanisms (such as those associated with inflammation or infection), which may involve somatic or visceral tissue; chronic pain mechanisms, which especially involve the CNS; emotional, cognitive, behavioural and sexual responses and mechanisms. […] Symptoms and signs of neuropathic pain appear to be common in CPPPS patients and assessment of neuropathic pain should be considered in that group of patients including those with secondary pelvic pain and other pelvic pathologies. […] It is important to appreciate that nociception is the process of transmitting information to centres involved in perception of a stimulus that has the potential to cause tissue damage. Pain is far more complex and involves activation of the nociceptive pathways but also the emotional response. […] Neuronal sensitisation is responsible for a decrease in threshold and an increase in response duration and magnitude of dorsal horn neurons. […] As a result, sensitisation increases signalling to the CNS and amplifies what we perceive from a peripheral stimulus.

• #10 EAU Guidelines on Chronic Pelvic Pain – Uroweb

  https://uroweb.org/guidelines/chronic-pelvic-pain/chapter/epidemiology-aetiology-and-pathophysiology

  The mechanisms that serve as an underlying cause for chronic pelvic pain are: ongoing acute pain mechanisms (such as those associated with inflammation or infection), which may involve somatic or visceral tissue; chronic pain mechanisms, which especially involve the CNS; emotional, cognitive, behavioural and sexual responses and mechanisms. […] Symptoms and signs of neuropathic pain appear to be common in CPPPS patients and assessment of neuropathic pain should be considered in that group of patients including those with secondary pelvic pain and other pelvic pathologies. […] It is important to appreciate that nociception is the process of transmitting information to centres involved in perception of a stimulus that has the potential to cause tissue damage. Pain is far more complex and involves activation of the nociceptive pathways but also the emotional response. […] Neuronal sensitisation is responsible for a decrease in threshold and an increase in response duration and magnitude of dorsal horn neurons. […] As a result, sensitisation increases signalling to the CNS and amplifies what we perceive from a peripheral stimulus.

• #11 New Concepts on Functional Chronic Pelvic and Perineal Pain: Pathophysiology and Multidisciplinary Management – Stephane Ploteau – Discovery Medicine

  https://www.discoverymedicine.com/Stephane-Ploteau/2015/03/new-concepts-on-functional-chronic-pelvic-and-perineal-pain-pathophysiology-and-multidisciplinary-management/

  The management of chronic pelvic and perineal pain has been improved by a better understanding of the mechanisms of this pain and an optimized integrated multidisciplinary approach to the patient. […] The concept of organic lesions responsible for a persistent nociceptive factor has gradually been replaced by that of dysregulation of nociceptive messages derived from the pelvis and perineum. […] Chronic pelvic pain can be considered to reflect dysfunction of the nociceptive system rather than a direct consequence of continuous nociceptive stimulation of the organ. […] Disorders of cortical responses to pain in patients with chronic pelvic and perineal pain (Labat et al., 2010), demonstrated by PET scan and functional MRI, reflect the supraspinal neuroplasticity induced by repetition of the nociceptive message.

• #12 New Concepts on Functional Chronic Pelvic and Perineal Pain: Pathophysiology and Multidisciplinary Management – Stephane Ploteau – Discovery Medicine

  https://www.discoverymedicine.com/Stephane-Ploteau/2015/03/new-concepts-on-functional-chronic-pelvic-and-perineal-pain-pathophysiology-and-multidisciplinary-management/

  The management of chronic pelvic and perineal pain has been improved by a better understanding of the mechanisms of this pain and an optimized integrated multidisciplinary approach to the patient. […] The concept of organic lesions responsible for a persistent nociceptive factor has gradually been replaced by that of dysregulation of nociceptive messages derived from the pelvis and perineum. […] Chronic pelvic pain can be considered to reflect dysfunction of the nociceptive system rather than a direct consequence of continuous nociceptive stimulation of the organ. […] Disorders of cortical responses to pain in patients with chronic pelvic and perineal pain (Labat et al., 2010), demonstrated by PET scan and functional MRI, reflect the supraspinal neuroplasticity induced by repetition of the nociceptive message.

• #13 New Concepts on Functional Chronic Pelvic and Perineal Pain: Pathophysiology and Multidisciplinary Management – Stephane Ploteau – Discovery Medicine

  https://www.discoverymedicine.com/Stephane-Ploteau/2015/03/new-concepts-on-functional-chronic-pelvic-and-perineal-pain-pathophysiology-and-multidisciplinary-management/

  The management of chronic pelvic and perineal pain has been improved by a better understanding of the mechanisms of this pain and an optimized integrated multidisciplinary approach to the patient. […] The concept of organic lesions responsible for a persistent nociceptive factor has gradually been replaced by that of dysregulation of nociceptive messages derived from the pelvis and perineum. […] Chronic pelvic pain can be considered to reflect dysfunction of the nociceptive system rather than a direct consequence of continuous nociceptive stimulation of the organ. […] Disorders of cortical responses to pain in patients with chronic pelvic and perineal pain (Labat et al., 2010), demonstrated by PET scan and functional MRI, reflect the supraspinal neuroplasticity induced by repetition of the nociceptive message.

• #14 EAU Guidelines on Chronic Pelvic Pain – Uroweb

  https://uroweb.org/guidelines/chronic-pelvic-pain/chapter/epidemiology-aetiology-and-pathophysiology

  Over the years much of the focus for CPPPS has been on peripheral-end-organ mechanisms, such as inflammatory or infective conditions. However, both animal and clinical research have indicated that many of the mechanisms for the CPPPSs are based within the CNS. […] Although ongoing peripheral organ pathology can produce persistent and chronic pain, the main focus of these guidelines is on CPPPSs in which no peripheral ongoing pathology (such as infection or neoplastic disease) is detected. The main exception is when pain is due to peripheral nerve damage. […] Risk factors include many different factors from various areas, including genetic, psychological state, recurrent physical trauma and endocrine factors. […] Studies about integrating the psychological factors of CPPPSs are few but the quality is high. Psychological factors are consistently found to be relevant in the maintenance of persistent pelvic and urogenital pain. […] The various mechanisms of CNS facilitation, amplification and failure of inhibition mean that there is no simple relationship between physical findings, pain experience and resulting distress and restriction of activities.

• #15 EAU Guidelines on Chronic Pelvic Pain – Uroweb

  https://uroweb.org/guidelines/chronic-pelvic-pain/chapter/epidemiology-aetiology-and-pathophysiology

  The mechanisms that serve as an underlying cause for chronic pelvic pain are: ongoing acute pain mechanisms (such as those associated with inflammation or infection), which may involve somatic or visceral tissue; chronic pain mechanisms, which especially involve the CNS; emotional, cognitive, behavioural and sexual responses and mechanisms. […] Symptoms and signs of neuropathic pain appear to be common in CPPPS patients and assessment of neuropathic pain should be considered in that group of patients including those with secondary pelvic pain and other pelvic pathologies. […] It is important to appreciate that nociception is the process of transmitting information to centres involved in perception of a stimulus that has the potential to cause tissue damage. Pain is far more complex and involves activation of the nociceptive pathways but also the emotional response. […] Neuronal sensitisation is responsible for a decrease in threshold and an increase in response duration and magnitude of dorsal horn neurons. […] As a result, sensitisation increases signalling to the CNS and amplifies what we perceive from a peripheral stimulus.

• #16 EAU Guidelines on Chronic Pelvic Pain – Uroweb

  https://uroweb.org/guidelines/chronic-pelvic-pain/chapter/epidemiology-aetiology-and-pathophysiology

  The mechanisms that serve as an underlying cause for chronic pelvic pain are: ongoing acute pain mechanisms (such as those associated with inflammation or infection), which may involve somatic or visceral tissue; chronic pain mechanisms, which especially involve the CNS; emotional, cognitive, behavioural and sexual responses and mechanisms. […] Symptoms and signs of neuropathic pain appear to be common in CPPPS patients and assessment of neuropathic pain should be considered in that group of patients including those with secondary pelvic pain and other pelvic pathologies. […] It is important to appreciate that nociception is the process of transmitting information to centres involved in perception of a stimulus that has the potential to cause tissue damage. Pain is far more complex and involves activation of the nociceptive pathways but also the emotional response. […] Neuronal sensitisation is responsible for a decrease in threshold and an increase in response duration and magnitude of dorsal horn neurons. […] As a result, sensitisation increases signalling to the CNS and amplifies what we perceive from a peripheral stimulus.

• #17 Dietary therapy: a new strategy for management of chronic pelvic pain | Nutrition Research Reviews | Cambridge Core

  https://www.cambridge.org/core/journals/nutrition-research-reviews/article/dietary-therapy-a-new-strategy-for-management-of-chronic-pelvic-pain/19E868FB1BE3A08DCFC0D00D7489ACAF

  Inflammatory pain is due to the response to tissue injury and the resulting inflammatory process; it may be a normal pain, but in some cases it becomes chronic or persistent and represents a pathological pain mechanism. […] Neuropathic pain is usually accompanied by nerve injury or prolonged neuronal pressure but, additionally, the activation of cells involved in the immune response may contribute indirectly to the development of CPP and frequently leads to a chronic pain state by neural plasticity and central sensitisation. […] Given the limited data and complex environment of the peritoneal cavity, it is unclear when and why oxidative stress may occur in relation to CPP. […] It has been suggested that in women with endometriosis-related CPP there is an increased peritoneal level of lipid peroxidation markers and their by-products in a macrophage-rich inflammatory milieu.

• #18 Endometriosis-Related Chronic Pelvic Pain

  https://www.mdpi.com/2227-9059/11/10/2868

  Endometriosis, which is the presence of endometrial stroma and glands outside the uterus, is one of the most frequently diagnosed gynecologic diseases in reproductive women. Patients with endometriosis suffer from various pain symptoms such as dysmenorrhea, dyspareunia, and chronic pelvic pain. The pathophysiology for chronic pain in patients with endometriosis has not been fully understood. Altered inflammatory responses have been shown to contribute to pain symptoms. Increased secretion of cytokines, angiogenic factors, and nerve growth factors has been suggested to increase pain. Also, altered distribution of nerve fibers may also contribute to chronic pain. […] Chronic pelvic pain does not directly correlate with the size of the lesion or the severity of the disease. In some cases, the pain remains even after the surgical removal of endometrial lesions, and chronic pain recurs in patients after 12 months. Moreover, patients with endometriosis have many comorbid chronic pain syndromes such as irritable bowel syndrome, painful bladder syndrome, vulvar vestibulodynia, and abdomino-pelvic myalgia, suggesting a complex mechanism behind endometriosis-associated pain.

• #19 Chronic Pelvic Pain in Men: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/437745-overview

  An imbalance in this complex network of cytokines (ie, of proinflammatory cytokines and endogenous cytokine inhibitors) has been linked to the development of pelvic inflammation and pain in patients with CPPS. […] Autoimmunity has long been thought to play a role in the development of CPPS. […] Abnormal functioning of the nervous system, at the local level and/or within the central nervous system (CNS), may also play a role in the development of CPPS. […] Each of the above factors has been individually identified as a culprit in the pathogenesis of CPPS; additionally, at least in some cases, they may interact with each other to cause CPPS. […] Psychological stress and depression have long been associated with CPPS flare-ups. […] Some cases of „nonbacterial” prostatitis may not actually be nonbacterial.

• #20 Endometriosis-Related Chronic Pelvic Pain

  https://www.mdpi.com/2227-9059/11/10/2868

  Endometriosis is known to be a chronic inflammatory disease. Endometriotic lesions and the peritoneal fluid of endometriosis patients contain many inflammatory cells, cytokines, and chemokines, creating an inflammatory microenvironment. The most commonly accepted theory of endometriosis is retrograde menstruation, which is the implantation of endometrial cells into the pelvic cavity during normal menstruation. […] This vicious cycle can further enhance the growth and infiltration of endometriotic lesions and induce a chronic inflammatory microenvironment, and thus chronic pelvic pain. […] The aberrant innervation of endometriotic lesions is considered pivotal in the role of chronic pelvic pain in endometriosis patients. Pain is a process in which noxious stimuli are recognized at the level of peripheral nerve fibers called nociceptors and transmitted to the spinal cord and brain.

• #21 Endometriosis-Related Chronic Pelvic Pain

  https://www.mdpi.com/2227-9059/11/10/2868

  Endometriosis is known to be a chronic inflammatory disease. Endometriotic lesions and the peritoneal fluid of endometriosis patients contain many inflammatory cells, cytokines, and chemokines, creating an inflammatory microenvironment. The most commonly accepted theory of endometriosis is retrograde menstruation, which is the implantation of endometrial cells into the pelvic cavity during normal menstruation. […] This vicious cycle can further enhance the growth and infiltration of endometriotic lesions and induce a chronic inflammatory microenvironment, and thus chronic pelvic pain. […] The aberrant innervation of endometriotic lesions is considered pivotal in the role of chronic pelvic pain in endometriosis patients. Pain is a process in which noxious stimuli are recognized at the level of peripheral nerve fibers called nociceptors and transmitted to the spinal cord and brain.

• #22 Chronic Pelvic Pain in Men: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/437745-overview

  An imbalance in this complex network of cytokines (ie, of proinflammatory cytokines and endogenous cytokine inhibitors) has been linked to the development of pelvic inflammation and pain in patients with CPPS. […] Autoimmunity has long been thought to play a role in the development of CPPS. […] Abnormal functioning of the nervous system, at the local level and/or within the central nervous system (CNS), may also play a role in the development of CPPS. […] Each of the above factors has been individually identified as a culprit in the pathogenesis of CPPS; additionally, at least in some cases, they may interact with each other to cause CPPS. […] Psychological stress and depression have long been associated with CPPS flare-ups. […] Some cases of „nonbacterial” prostatitis may not actually be nonbacterial.

• #23 Chronic Pelvic Pain in Men: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/437745-overview

  These findings might help explain why antibiotics can be helpful in treating an initial bout of acute prostatitis, and yet be ineffective in relieving subsequent bouts. […] Findings of spastic hyperactivity on videourodynamic studies, in the absence of a definable underlying neuropathy, suggest the presence of either an occult neural etiology or an acquired functional voiding disorder. […] An autoimmune basis for chronic prostatitis has been well established in different murine models. […] Several studies now demonstrate that men with CP/CPPS show evidence of having a pan-pelvic hypersensitivity syndrome.

• #24 Molecular mechanism and promising treatments of chronic prostatitis/chronic pelvic pain syndrome: An exploratory bibliometric analysis and literature review of preclinical studies

  https://journal.hep.com.cn/up/EN/10.1002/uro2.34

  As one of the most common diseases in urology, a large number of preclinical studies have been accumulated to explore the etiological mechanism and potential intervention of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). […] According to the results of this study, the most common mechanisms involved in CP/CPPS were as follows: Disturbed immune and inflammation mediators, immune cell dysfunction, oxidative stress, dysregulated signaling pathways, apoptosis, gut microbiota, and testosterone metabolism. […] Traditional Chinese Medicine and extracorporeal shock wave therapy have important potential in the treatment of CP/CPPS. […] Further translational studies targeting the above mechanisms and validating the objective efficacy of potential treatments indicated by preclinical studies in clinical patients are needed in the future.

• #25 Chronic Pelvic Pain in Men: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/437745-overview

  An imbalance in this complex network of cytokines (ie, of proinflammatory cytokines and endogenous cytokine inhibitors) has been linked to the development of pelvic inflammation and pain in patients with CPPS. […] Autoimmunity has long been thought to play a role in the development of CPPS. […] Abnormal functioning of the nervous system, at the local level and/or within the central nervous system (CNS), may also play a role in the development of CPPS. […] Each of the above factors has been individually identified as a culprit in the pathogenesis of CPPS; additionally, at least in some cases, they may interact with each other to cause CPPS. […] Psychological stress and depression have long been associated with CPPS flare-ups. […] Some cases of „nonbacterial” prostatitis may not actually be nonbacterial.

• #26 Endometriosis-Related Chronic Pelvic Pain

  https://www.mdpi.com/2227-9059/11/10/2868

  Peripheral sensitization is one mechanism that can explain the persistence of pain even without lesions. Nociceptors can become more susceptible to pain after local tissue injury or the inflammatory process, due to neuroplasticity of the peripheral sensory nerve. […] Central sensitization seems to play an important role in converting nociception to chronic pain. Central sensitization is defined as the “increased responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold afferent input.” […] Understanding the mechanism behind this complex condition can aid physicians in better understanding patients and ultimately develop an effective treatment modality to alleviate symptoms of patients who suffer from chronic pelvic pain associated with endometriosis.

• #27 Endometriosis-Related Chronic Pelvic Pain

  https://www.mdpi.com/2227-9059/11/10/2868

  Peripheral sensitization is one mechanism that can explain the persistence of pain even without lesions. Nociceptors can become more susceptible to pain after local tissue injury or the inflammatory process, due to neuroplasticity of the peripheral sensory nerve. […] Central sensitization seems to play an important role in converting nociception to chronic pain. Central sensitization is defined as the “increased responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold afferent input.” […] Understanding the mechanism behind this complex condition can aid physicians in better understanding patients and ultimately develop an effective treatment modality to alleviate symptoms of patients who suffer from chronic pelvic pain associated with endometriosis.

• #28 Chronic Pelvic Pain in Men: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/437745-overview

  These findings might help explain why antibiotics can be helpful in treating an initial bout of acute prostatitis, and yet be ineffective in relieving subsequent bouts. […] Findings of spastic hyperactivity on videourodynamic studies, in the absence of a definable underlying neuropathy, suggest the presence of either an occult neural etiology or an acquired functional voiding disorder. […] An autoimmune basis for chronic prostatitis has been well established in different murine models. […] Several studies now demonstrate that men with CP/CPPS show evidence of having a pan-pelvic hypersensitivity syndrome.

• #29 Endometriosis-Related Chronic Pelvic Pain

  https://www.mdpi.com/2227-9059/11/10/2868

  Endometriosis is known to be a chronic inflammatory disease. Endometriotic lesions and the peritoneal fluid of endometriosis patients contain many inflammatory cells, cytokines, and chemokines, creating an inflammatory microenvironment. The most commonly accepted theory of endometriosis is retrograde menstruation, which is the implantation of endometrial cells into the pelvic cavity during normal menstruation. […] This vicious cycle can further enhance the growth and infiltration of endometriotic lesions and induce a chronic inflammatory microenvironment, and thus chronic pelvic pain. […] The aberrant innervation of endometriotic lesions is considered pivotal in the role of chronic pelvic pain in endometriosis patients. Pain is a process in which noxious stimuli are recognized at the level of peripheral nerve fibers called nociceptors and transmitted to the spinal cord and brain.

• #30 :: WJMH :: World Journal of Men’s Health

  https://wjmh.org/DOIx.php?id=10.5534/wjmh.220248

  Currently, the pathogenesis of CP/CPPS involves immunological, endocrine, and psychological etiologies and autonomic nervous systems. The autonomic nervous system seems to be the link between them. The autonomic nervous system comprises sensory, sympathetic, and parasympathetic nerves and the central nervous system (CNS). Sensory nerves are related to neuro-inflammation. The persistence of chronic pelvic pain and its sensitization might also be responsible for recurrent conditions and prolonged pain in chronic prostatitis. […] Moreover, the cardiovascular system and male reproductive function are altered in CP/CPPS as well as patients with vasogenic impotence have autonomic dysfunction. In addition, some studies elucidated that central sensitization also played an essential role in developing and maintaining chronic pain in the case of perpetual pain without inflammatory conditions. Therefore, this review collated and described the specific processes and mechanisms of the autonomic nervous system in developing CP/CPPS. Furthermore, this review illustrates the neurologically-relevant substances and channels or receptors involved in this process.

• #31 :: WJMH :: World Journal of Men’s Health

  https://wjmh.org/DOIx.php?id=10.5534/wjmh.220248

  Sensory nerves are associated with neurogenetic inflammation and pain. Sensory nerves activate and release substance P (SP) and calcitonin gene-related peptide (CGRP) when nociceptors are stimulated in their terminals. CGRP- and SP-expressing nerves densely innervate vascular smooth muscles. Therefore, these substances will directly affect the vascular endothelial cells to participate in vascular effects, mediating the generation of neurogenetic inflammation. […] Sympathetic and parasympathetic nerves play an essential role in the generation and development of inflammation, pain, and dysfunctional organs. […] Overall, sympathetic and parasympathetic nerves play a vital role in developing prostatitis, chronic pain, cross-sensitization, and organ dysfunction. The symptoms of the urinary system are similar to CP/CPPS.

• #32 :: WJMH :: World Journal of Men’s Health

  https://wjmh.org/DOIx.php?id=10.5534/wjmh.220248

  Sensory nerves are associated with neurogenetic inflammation and pain. Sensory nerves activate and release substance P (SP) and calcitonin gene-related peptide (CGRP) when nociceptors are stimulated in their terminals. CGRP- and SP-expressing nerves densely innervate vascular smooth muscles. Therefore, these substances will directly affect the vascular endothelial cells to participate in vascular effects, mediating the generation of neurogenetic inflammation. […] Sympathetic and parasympathetic nerves play an essential role in the generation and development of inflammation, pain, and dysfunctional organs. […] Overall, sympathetic and parasympathetic nerves play a vital role in developing prostatitis, chronic pain, cross-sensitization, and organ dysfunction. The symptoms of the urinary system are similar to CP/CPPS.

• #33 :: WJMH :: World Journal of Men’s Health

  https://wjmh.org/DOIx.php?id=10.5534/wjmh.220248

  Central nervous sensitization contributes to the pathogenesis of pain and dysfunctional changes in organs. Central sensitization is characterized by extensive pain, multi-site hyperalgesia, and abnormal pain. Furthermore, it may be accompanied by abnormal organ function, cognitive impairment, depression, and other emotional problems. Chronic prostatitis can also cause generalized pelvic pain, scrotum, bladder, and other organ pain sensitivity. […] Several researchers have suggested that autonomic nervous system dysfunction is closely associated with CP/CPPS. Sensory nerves lead to persistent inflammation and pain. Sympathetic and parasympathetic alterations affect the dysfunction of organs and the development of prostatitis. Central sensitization decreases pain thresholds and increases pelvic pain perception in chronic prostatitis.

• #34 Chronic Pelvic Pain | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26872

  Chronic pelvic pain is a form of centralized pain, where the body develops a lower threshold for discomfort or uncomfortable sensations, often as a result of chronic pain. For example, in women with endometriosis, the acute pain associated with the condition can become centralized over a 3- to 6-month period, evolving into chronic pain. […] The pathophysiology of chronic pelvic pain is thought to involve centralized pain mechanisms. Patients with chronic pelvic pain often develop hyperesthesia and allodynia, which are frequently exacerbated by pelvic floor dysfunction. […] Chronic pelvic pain is often secondary to comorbid conditions that cause chronic pain. A synergistic effect can occur when dysfunction in an organ system leads to issues in another. […] The pathophysiology of chronic pelvic pain varies depending on the underlying condition. In endometriosis, cyclical pain arises from recurrent bleeding of ectopic endometrial implants, leading to inflammation and neurogenic sensitization. In pelvic congestion syndrome, dilated and engorged pelvic veins produce mechanical and ischemic pain. However, the majority of chronic pelvic pain cases are driven by central sensitization, a process in which persistent pain alters the nervous system, heightening sensitivity and amplifying discomfort, even after the original pathology has resolved.

• #35 Chronic Pelvic Pain | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26872

  Chronic pelvic pain is a form of centralized pain, where the body develops a lower threshold for discomfort or uncomfortable sensations, often as a result of chronic pain. For example, in women with endometriosis, the acute pain associated with the condition can become centralized over a 3- to 6-month period, evolving into chronic pain. […] The pathophysiology of chronic pelvic pain is thought to involve centralized pain mechanisms. Patients with chronic pelvic pain often develop hyperesthesia and allodynia, which are frequently exacerbated by pelvic floor dysfunction. […] Chronic pelvic pain is often secondary to comorbid conditions that cause chronic pain. A synergistic effect can occur when dysfunction in an organ system leads to issues in another. […] The pathophysiology of chronic pelvic pain varies depending on the underlying condition. In endometriosis, cyclical pain arises from recurrent bleeding of ectopic endometrial implants, leading to inflammation and neurogenic sensitization. In pelvic congestion syndrome, dilated and engorged pelvic veins produce mechanical and ischemic pain. However, the majority of chronic pelvic pain cases are driven by central sensitization, a process in which persistent pain alters the nervous system, heightening sensitivity and amplifying discomfort, even after the original pathology has resolved.

• #36 Endometriosis-Related Chronic Pelvic Pain

  https://www.mdpi.com/2227-9059/11/10/2868

  Endometriosis, which is the presence of endometrial stroma and glands outside the uterus, is one of the most frequently diagnosed gynecologic diseases in reproductive women. Patients with endometriosis suffer from various pain symptoms such as dysmenorrhea, dyspareunia, and chronic pelvic pain. The pathophysiology for chronic pain in patients with endometriosis has not been fully understood. Altered inflammatory responses have been shown to contribute to pain symptoms. Increased secretion of cytokines, angiogenic factors, and nerve growth factors has been suggested to increase pain. Also, altered distribution of nerve fibers may also contribute to chronic pain. […] Chronic pelvic pain does not directly correlate with the size of the lesion or the severity of the disease. In some cases, the pain remains even after the surgical removal of endometrial lesions, and chronic pain recurs in patients after 12 months. Moreover, patients with endometriosis have many comorbid chronic pain syndromes such as irritable bowel syndrome, painful bladder syndrome, vulvar vestibulodynia, and abdomino-pelvic myalgia, suggesting a complex mechanism behind endometriosis-associated pain.

• #37 Endometriosis-Related Chronic Pelvic Pain

  https://www.mdpi.com/2227-9059/11/10/2868

  Endometriosis, which is the presence of endometrial stroma and glands outside the uterus, is one of the most frequently diagnosed gynecologic diseases in reproductive women. Patients with endometriosis suffer from various pain symptoms such as dysmenorrhea, dyspareunia, and chronic pelvic pain. The pathophysiology for chronic pain in patients with endometriosis has not been fully understood. Altered inflammatory responses have been shown to contribute to pain symptoms. Increased secretion of cytokines, angiogenic factors, and nerve growth factors has been suggested to increase pain. Also, altered distribution of nerve fibers may also contribute to chronic pain. […] Chronic pelvic pain does not directly correlate with the size of the lesion or the severity of the disease. In some cases, the pain remains even after the surgical removal of endometrial lesions, and chronic pain recurs in patients after 12 months. Moreover, patients with endometriosis have many comorbid chronic pain syndromes such as irritable bowel syndrome, painful bladder syndrome, vulvar vestibulodynia, and abdomino-pelvic myalgia, suggesting a complex mechanism behind endometriosis-associated pain.

• #38 Endometriosis-Related Chronic Pelvic Pain

  https://www.mdpi.com/2227-9059/11/10/2868

  Endometriosis, which is the presence of endometrial stroma and glands outside the uterus, is one of the most frequently diagnosed gynecologic diseases in reproductive women. Patients with endometriosis suffer from various pain symptoms such as dysmenorrhea, dyspareunia, and chronic pelvic pain. The pathophysiology for chronic pain in patients with endometriosis has not been fully understood. Altered inflammatory responses have been shown to contribute to pain symptoms. Increased secretion of cytokines, angiogenic factors, and nerve growth factors has been suggested to increase pain. Also, altered distribution of nerve fibers may also contribute to chronic pain. […] Chronic pelvic pain does not directly correlate with the size of the lesion or the severity of the disease. In some cases, the pain remains even after the surgical removal of endometrial lesions, and chronic pain recurs in patients after 12 months. Moreover, patients with endometriosis have many comorbid chronic pain syndromes such as irritable bowel syndrome, painful bladder syndrome, vulvar vestibulodynia, and abdomino-pelvic myalgia, suggesting a complex mechanism behind endometriosis-associated pain.

• #39 Chronic Pelvic Pain | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26872

  Chronic pelvic pain is a form of centralized pain, where the body develops a lower threshold for discomfort or uncomfortable sensations, often as a result of chronic pain. For example, in women with endometriosis, the acute pain associated with the condition can become centralized over a 3- to 6-month period, evolving into chronic pain. […] The pathophysiology of chronic pelvic pain is thought to involve centralized pain mechanisms. Patients with chronic pelvic pain often develop hyperesthesia and allodynia, which are frequently exacerbated by pelvic floor dysfunction. […] Chronic pelvic pain is often secondary to comorbid conditions that cause chronic pain. A synergistic effect can occur when dysfunction in an organ system leads to issues in another. […] The pathophysiology of chronic pelvic pain varies depending on the underlying condition. In endometriosis, cyclical pain arises from recurrent bleeding of ectopic endometrial implants, leading to inflammation and neurogenic sensitization. In pelvic congestion syndrome, dilated and engorged pelvic veins produce mechanical and ischemic pain. However, the majority of chronic pelvic pain cases are driven by central sensitization, a process in which persistent pain alters the nervous system, heightening sensitivity and amplifying discomfort, even after the original pathology has resolved.

• #40 Pelvic congestion syndrome as a differential diagnosis of chronic pelvic pain in women | Clinics

  https://www.elsevier.es/en-revista-clinics-22-articulo-pelvic-congestion-syndrome-as-differential-S1807593224001911

  Chronic Pelvic Pain (CPP) is a symptom reported by many women during gynecologist visits and whose cause often remains unknown. According to the Centers for Disease Control and Prevention of the USA (CDC), CPP accounts for nearly 9% of all appointments to gynecologists. Moreover, CPP is responsible for 20%30% of all laparoscopies in adults.1,2 […] Among the differential diagnoses (endometriosis, adenomyosis, pelvic inflammatory disease, adhesions, urological, gastrointestinal, musculoskeletal causes, among others), Pelvic Venous Congestion Syndrome (PVCS) might be perhaps the least considered. However, PVCS may account for one-third of the real causes of CPP in women during the evaluation after all other causes of pain have been excluded.2 […] The pathophysiology of PVCS is not yet fully understood, but it is known that common causes of varicosities in other regions also play a role in the female pelvic region, such as valve incompetence, blood reflux, and venous engorgement. In addition, ovarian hormonal dysfunction has been suggested to play an important role, since estrogen is known to act as a venous vasodilator.4

• #41 Pelvic congestion syndrome as a differential diagnosis of chronic pelvic pain in women | Clinics

  https://www.elsevier.es/en-revista-clinics-22-articulo-pelvic-congestion-syndrome-as-differential-S1807593224001911

  Chronic Pelvic Pain (CPP) is a symptom reported by many women during gynecologist visits and whose cause often remains unknown. According to the Centers for Disease Control and Prevention of the USA (CDC), CPP accounts for nearly 9% of all appointments to gynecologists. Moreover, CPP is responsible for 20%30% of all laparoscopies in adults.1,2 […] Among the differential diagnoses (endometriosis, adenomyosis, pelvic inflammatory disease, adhesions, urological, gastrointestinal, musculoskeletal causes, among others), Pelvic Venous Congestion Syndrome (PVCS) might be perhaps the least considered. However, PVCS may account for one-third of the real causes of CPP in women during the evaluation after all other causes of pain have been excluded.2 […] The pathophysiology of PVCS is not yet fully understood, but it is known that common causes of varicosities in other regions also play a role in the female pelvic region, such as valve incompetence, blood reflux, and venous engorgement. In addition, ovarian hormonal dysfunction has been suggested to play an important role, since estrogen is known to act as a venous vasodilator.4

• #42 Pelvic congestion syndrome as a differential diagnosis of chronic pelvic pain in women | Clinics

  https://www.elsevier.es/en-revista-clinics-22-articulo-pelvic-congestion-syndrome-as-differential-S1807593224001911

  The anatomy of the venous drainage of the female pelvis may interfere with the pelvic vein dilatation The left ovarian vein flows into the ipsilateral renal vein at a 90 angle, unlike the opening of the right ovarian vein into the inferior vena cava (at an acute angle), which may justify findings of larger venous diameters on the left. Venous compressions leading to stasis such as May-Thurner and/or Nutcracker syndrome also contribute to the etiology of pelvic congestion.4 […] The diagnosis of pelvic venous congestion syndrome is based on a combination of signs and symptoms, physical examination, and documentation of dilated vessels or pelvic vein incompetence, after excluding other causes. Although the absence of pelvic venous changes helps to exclude PVCS, the presence of these abnormalities is not a diagnostic criterion. Findings of venous dilation on imaging tests must be carefully evaluated and associated with a suggestive clinical picture for diagnostic elucidation.4 […] According to literature evidence, endovascular techniques such as iliac and renal angioplasty and gonadal vein embolization have been considered the best alternative in the current scientific scenario and further research is necessary in the field.4,9

• #43 Chronic Pelvic Pain in Men: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/437745-overview

  The term chronic pelvic pain syndrome (CPPS) is used to designate unexplained chronic pelvic pain in men. This pain is associated with irritative voiding symptoms and/or pain in the groin, genitalia, or perineum in the absence of pyuria and bacteriuria (no pus cells or bacteria seen on microscopic analysis of the urine). […] Current research has provided evidence of numerous extraprostatic considerations, including neuropathic and other systemic pathologies. […] Pontari and Ruggieri reviewed the numerous pathophysiologic mechanisms implicated as the potential etiologies of CPPS and concluded that, although the causes of CPPS remain unknown, the conditions symptoms seem to arise from the interaction between psychological factors and immune, neurologic, and endocrine system dysfunction. […] The number of WBCs (pus cells) found in the prostatic fluid under microscopic examination long considered the hallmark of this disease process does not correlate with the degree of pain or with other symptoms experienced by patients with CPPS.

• #44 Chronic Pelvic Pain in Men: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/437745-overview

  The term chronic pelvic pain syndrome (CPPS) is used to designate unexplained chronic pelvic pain in men. This pain is associated with irritative voiding symptoms and/or pain in the groin, genitalia, or perineum in the absence of pyuria and bacteriuria (no pus cells or bacteria seen on microscopic analysis of the urine). […] Current research has provided evidence of numerous extraprostatic considerations, including neuropathic and other systemic pathologies. […] Pontari and Ruggieri reviewed the numerous pathophysiologic mechanisms implicated as the potential etiologies of CPPS and concluded that, although the causes of CPPS remain unknown, the conditions symptoms seem to arise from the interaction between psychological factors and immune, neurologic, and endocrine system dysfunction. […] The number of WBCs (pus cells) found in the prostatic fluid under microscopic examination long considered the hallmark of this disease process does not correlate with the degree of pain or with other symptoms experienced by patients with CPPS.

• #45 Chronic Pelvic Pain in Men: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/437745-overview

  The term chronic pelvic pain syndrome (CPPS) is used to designate unexplained chronic pelvic pain in men. This pain is associated with irritative voiding symptoms and/or pain in the groin, genitalia, or perineum in the absence of pyuria and bacteriuria (no pus cells or bacteria seen on microscopic analysis of the urine). […] Current research has provided evidence of numerous extraprostatic considerations, including neuropathic and other systemic pathologies. […] Pontari and Ruggieri reviewed the numerous pathophysiologic mechanisms implicated as the potential etiologies of CPPS and concluded that, although the causes of CPPS remain unknown, the conditions symptoms seem to arise from the interaction between psychological factors and immune, neurologic, and endocrine system dysfunction. […] The number of WBCs (pus cells) found in the prostatic fluid under microscopic examination long considered the hallmark of this disease process does not correlate with the degree of pain or with other symptoms experienced by patients with CPPS.

• #46 EAU Guidelines on Chronic Pelvic Pain – Uroweb

  https://uroweb.org/guidelines/chronic-pelvic-pain/chapter/epidemiology-aetiology-and-pathophysiology

  Over the years much of the focus for CPPPS has been on peripheral-end-organ mechanisms, such as inflammatory or infective conditions. However, both animal and clinical research have indicated that many of the mechanisms for the CPPPSs are based within the CNS. […] Although ongoing peripheral organ pathology can produce persistent and chronic pain, the main focus of these guidelines is on CPPPSs in which no peripheral ongoing pathology (such as infection or neoplastic disease) is detected. The main exception is when pain is due to peripheral nerve damage. […] Risk factors include many different factors from various areas, including genetic, psychological state, recurrent physical trauma and endocrine factors. […] Studies about integrating the psychological factors of CPPPSs are few but the quality is high. Psychological factors are consistently found to be relevant in the maintenance of persistent pelvic and urogenital pain. […] The various mechanisms of CNS facilitation, amplification and failure of inhibition mean that there is no simple relationship between physical findings, pain experience and resulting distress and restriction of activities.

• #47 EAU Guidelines on Chronic Pelvic Pain – Uroweb

  https://uroweb.org/guidelines/chronic-pelvic-pain/chapter/epidemiology-aetiology-and-pathophysiology

  Over the years much of the focus for CPPPS has been on peripheral-end-organ mechanisms, such as inflammatory or infective conditions. However, both animal and clinical research have indicated that many of the mechanisms for the CPPPSs are based within the CNS. […] Although ongoing peripheral organ pathology can produce persistent and chronic pain, the main focus of these guidelines is on CPPPSs in which no peripheral ongoing pathology (such as infection or neoplastic disease) is detected. The main exception is when pain is due to peripheral nerve damage. […] Risk factors include many different factors from various areas, including genetic, psychological state, recurrent physical trauma and endocrine factors. […] Studies about integrating the psychological factors of CPPPSs are few but the quality is high. Psychological factors are consistently found to be relevant in the maintenance of persistent pelvic and urogenital pain. […] The various mechanisms of CNS facilitation, amplification and failure of inhibition mean that there is no simple relationship between physical findings, pain experience and resulting distress and restriction of activities.

• #48 Chronic Pelvic Pain in Men: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/437745-overview

  An imbalance in this complex network of cytokines (ie, of proinflammatory cytokines and endogenous cytokine inhibitors) has been linked to the development of pelvic inflammation and pain in patients with CPPS. […] Autoimmunity has long been thought to play a role in the development of CPPS. […] Abnormal functioning of the nervous system, at the local level and/or within the central nervous system (CNS), may also play a role in the development of CPPS. […] Each of the above factors has been individually identified as a culprit in the pathogenesis of CPPS; additionally, at least in some cases, they may interact with each other to cause CPPS. […] Psychological stress and depression have long been associated with CPPS flare-ups. […] Some cases of „nonbacterial” prostatitis may not actually be nonbacterial.

• #49 Chronic Pelvic Pain in Women | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0301/p380.html

  The psychosocial context of the patient is important. Nearly one-half of women seeking care for chronic pelvic pain report a history of sexual, physical, or emotional trauma, and about one-third have positive screening results for posttraumatic stress disorder. […] Comprehensive guidelines for the diagnosis and treatment of chronic pelvic pain have been developed by the European Association of Urology. They include a description of the current understanding of pathophysiology and psychosocial aspects, as well as classification, diagnosis, and treatment.

• #50 Chronic Pelvic Pain in Women | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0601/p1535.html

• #51 Chronic Pelvic Pain in Women | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0601/p1535.html

• #52 EAU Guidelines on Chronic Pelvic Pain – Uroweb

  https://uroweb.org/guidelines/chronic-pelvic-pain/chapter/epidemiology-aetiology-and-pathophysiology

  Psychological processes of emotions, thought and behaviour involve networks rather than distinct centres. […] This psychological modulation may act to reduce nociception within a rapid time frame but may also result in long-term vulnerability to chronic visceral pain, through long-term potentiation. […] Pain studies describe multiple processes by which pain may spread across sites, or in time, including central sensitisation, viscero-visceral cross sensitisation in relation to multiple pain sites, activation of the hypothalamic-pituitary axis and dysregulation of serotonergic pathways that can render pain levels responsive to stress. […] Chronic pelvic pain is a clinical condition that results from complex interactions of physiological and psychological factors and has a direct impact on the social, personal and professional lives of men and women. […] Chronic pain as well as its treatment can impair our ability to express sexuality. […] The presence of pelvic pain may increase the risk for ED independent of age.

• #53 EAU Guidelines on Chronic Pelvic Pain – Uroweb

  https://uroweb.org/guidelines/chronic-pelvic-pain/chapter/epidemiology-aetiology-and-pathophysiology

  Psychological processes of emotions, thought and behaviour involve networks rather than distinct centres. […] This psychological modulation may act to reduce nociception within a rapid time frame but may also result in long-term vulnerability to chronic visceral pain, through long-term potentiation. […] Pain studies describe multiple processes by which pain may spread across sites, or in time, including central sensitisation, viscero-visceral cross sensitisation in relation to multiple pain sites, activation of the hypothalamic-pituitary axis and dysregulation of serotonergic pathways that can render pain levels responsive to stress. […] Chronic pelvic pain is a clinical condition that results from complex interactions of physiological and psychological factors and has a direct impact on the social, personal and professional lives of men and women. […] Chronic pain as well as its treatment can impair our ability to express sexuality. […] The presence of pelvic pain may increase the risk for ED independent of age.

• #54 EAU Guidelines on Chronic Pelvic Pain – Uroweb

  https://uroweb.org/guidelines/chronic-pelvic-pain/chapter/epidemiology-aetiology-and-pathophysiology

  Psychological processes of emotions, thought and behaviour involve networks rather than distinct centres. […] This psychological modulation may act to reduce nociception within a rapid time frame but may also result in long-term vulnerability to chronic visceral pain, through long-term potentiation. […] Pain studies describe multiple processes by which pain may spread across sites, or in time, including central sensitisation, viscero-visceral cross sensitisation in relation to multiple pain sites, activation of the hypothalamic-pituitary axis and dysregulation of serotonergic pathways that can render pain levels responsive to stress. […] Chronic pelvic pain is a clinical condition that results from complex interactions of physiological and psychological factors and has a direct impact on the social, personal and professional lives of men and women. […] Chronic pain as well as its treatment can impair our ability to express sexuality. […] The presence of pelvic pain may increase the risk for ED independent of age.

• #55 EAU Guidelines on Chronic Pelvic Pain – Uroweb

  https://uroweb.org/guidelines/chronic-pelvic-pain/chapter/epidemiology-aetiology-and-pathophysiology

  Psychological processes of emotions, thought and behaviour involve networks rather than distinct centres. […] This psychological modulation may act to reduce nociception within a rapid time frame but may also result in long-term vulnerability to chronic visceral pain, through long-term potentiation. […] Pain studies describe multiple processes by which pain may spread across sites, or in time, including central sensitisation, viscero-visceral cross sensitisation in relation to multiple pain sites, activation of the hypothalamic-pituitary axis and dysregulation of serotonergic pathways that can render pain levels responsive to stress. […] Chronic pelvic pain is a clinical condition that results from complex interactions of physiological and psychological factors and has a direct impact on the social, personal and professional lives of men and women. […] Chronic pain as well as its treatment can impair our ability to express sexuality. […] The presence of pelvic pain may increase the risk for ED independent of age.

• #56 EAU Guidelines on Chronic Pelvic Pain – Uroweb

  https://uroweb.org/guidelines/chronic-pelvic-pain/chapter/epidemiology-aetiology-and-pathophysiology

  Psychological processes of emotions, thought and behaviour involve networks rather than distinct centres. […] This psychological modulation may act to reduce nociception within a rapid time frame but may also result in long-term vulnerability to chronic visceral pain, through long-term potentiation. […] Pain studies describe multiple processes by which pain may spread across sites, or in time, including central sensitisation, viscero-visceral cross sensitisation in relation to multiple pain sites, activation of the hypothalamic-pituitary axis and dysregulation of serotonergic pathways that can render pain levels responsive to stress. […] Chronic pelvic pain is a clinical condition that results from complex interactions of physiological and psychological factors and has a direct impact on the social, personal and professional lives of men and women. […] Chronic pain as well as its treatment can impair our ability to express sexuality. […] The presence of pelvic pain may increase the risk for ED independent of age.

• #57 EAU Guidelines on Chronic Pelvic Pain – Uroweb

  https://uroweb.org/guidelines/chronic-pelvic-pain/chapter/epidemiology-aetiology-and-pathophysiology

  Psychological processes of emotions, thought and behaviour involve networks rather than distinct centres. […] This psychological modulation may act to reduce nociception within a rapid time frame but may also result in long-term vulnerability to chronic visceral pain, through long-term potentiation. […] Pain studies describe multiple processes by which pain may spread across sites, or in time, including central sensitisation, viscero-visceral cross sensitisation in relation to multiple pain sites, activation of the hypothalamic-pituitary axis and dysregulation of serotonergic pathways that can render pain levels responsive to stress. […] Chronic pelvic pain is a clinical condition that results from complex interactions of physiological and psychological factors and has a direct impact on the social, personal and professional lives of men and women. […] Chronic pain as well as its treatment can impair our ability to express sexuality. […] The presence of pelvic pain may increase the risk for ED independent of age.

• #58 Chronic Pelvic Pain | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26872

  Chronic pelvic pain is a form of centralized pain, where the body develops a lower threshold for discomfort or uncomfortable sensations, often as a result of chronic pain. For example, in women with endometriosis, the acute pain associated with the condition can become centralized over a 3- to 6-month period, evolving into chronic pain. […] The pathophysiology of chronic pelvic pain is thought to involve centralized pain mechanisms. Patients with chronic pelvic pain often develop hyperesthesia and allodynia, which are frequently exacerbated by pelvic floor dysfunction. […] Chronic pelvic pain is often secondary to comorbid conditions that cause chronic pain. A synergistic effect can occur when dysfunction in an organ system leads to issues in another. […] The pathophysiology of chronic pelvic pain varies depending on the underlying condition. In endometriosis, cyclical pain arises from recurrent bleeding of ectopic endometrial implants, leading to inflammation and neurogenic sensitization. In pelvic congestion syndrome, dilated and engorged pelvic veins produce mechanical and ischemic pain. However, the majority of chronic pelvic pain cases are driven by central sensitization, a process in which persistent pain alters the nervous system, heightening sensitivity and amplifying discomfort, even after the original pathology has resolved.

• #59 Chronic Pelvic Pain – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554585/

  Chronic pelvic pain is a persistent or recurrent pain in the lower abdomen or pelvis lasting at least 3 to 6 months. […] The clinical heterogeneity of chronic pelvic pain and its incompletely understood pathogenesis make treatment challenging. […] The pathophysiology of chronic pelvic pain is thought to involve centralized pain mechanisms. Patients with chronic pelvic pain often develop hyperesthesia and allodynia, which are frequently exacerbated by pelvic floor dysfunction. […] Chronic pelvic pain is often secondary to comorbid conditions that cause chronic pain. […] The prolonged nature of this pain increases the risk of central sensitization, contributing to the development of chronic pelvic pain. […] As comorbidities accumulate, the persistence of symptoms promotes central sensitization, further intensifying pain perception.

• #60 New Insights about Chronic Pelvic Pain Syndrome (CPPS)

  https://www.mdpi.com/1660-4601/17/9/3005

  Chronic pelvic pain syndrome (CPPS) is one of the common diseases in urology and gynecology. CPPS is a multifactorial disorder where pain may originate in any of the urogynecological, gastrointestinal, pelvic musculoskeletal, or nervous systems. The symptoms of CPPS appear to result from an interplay between psychological factors and dysfunction in the immune, neurological, and endocrine systems. […] CPPS represents a chronic pain syndrome that combines anatomic malfunction of the pelvic floor muscles with malfunction of pain perception linked with psychological and cognitive factors. […] A number of mechanisms have been suggested as the pathophysiological basis of CPPS: (1) An infection process, but no conclusive evidence has been found and antibiotic treatment is ineffective; (2) A neurogenic inflammation that includes local chemical changes; (3) Hypoxia. A disrupted blood flow to the pelvic area, reduced micro-vascular density of the bladder’s submucosa layer, followed by decreased perfusion is supported by clinical improvement following hyperbaric treatment; and (4) Weakness or cramps of the pelvic floor muscles. None of the above have been mentioned as the sole cause of the syndrome, and it is estimated that these mechanisms interact. A common explanation is that, for an unknown reason, the glycosaminoglycan (GAG) layer that coats the mucosa of the bladder and vagina is damaged. This damage leads to a chain of nerve-cell-level processes that culminate in a neurogenic inflammation and mast cell activation.

• #61 New Insights about Chronic Pelvic Pain Syndrome (CPPS)

  https://www.mdpi.com/1660-4601/17/9/3005

  Chronic pelvic pain syndrome (CPPS) is one of the common diseases in urology and gynecology. CPPS is a multifactorial disorder where pain may originate in any of the urogynecological, gastrointestinal, pelvic musculoskeletal, or nervous systems. The symptoms of CPPS appear to result from an interplay between psychological factors and dysfunction in the immune, neurological, and endocrine systems. […] CPPS represents a chronic pain syndrome that combines anatomic malfunction of the pelvic floor muscles with malfunction of pain perception linked with psychological and cognitive factors. […] A number of mechanisms have been suggested as the pathophysiological basis of CPPS: (1) An infection process, but no conclusive evidence has been found and antibiotic treatment is ineffective; (2) A neurogenic inflammation that includes local chemical changes; (3) Hypoxia. A disrupted blood flow to the pelvic area, reduced micro-vascular density of the bladder’s submucosa layer, followed by decreased perfusion is supported by clinical improvement following hyperbaric treatment; and (4) Weakness or cramps of the pelvic floor muscles. None of the above have been mentioned as the sole cause of the syndrome, and it is estimated that these mechanisms interact. A common explanation is that, for an unknown reason, the glycosaminoglycan (GAG) layer that coats the mucosa of the bladder and vagina is damaged. This damage leads to a chain of nerve-cell-level processes that culminate in a neurogenic inflammation and mast cell activation.

• #62 New Insights about Chronic Pelvic Pain Syndrome (CPPS)

  https://www.mdpi.com/1660-4601/17/9/3005

  Chronic pelvic pain syndrome (CPPS) is one of the common diseases in urology and gynecology. CPPS is a multifactorial disorder where pain may originate in any of the urogynecological, gastrointestinal, pelvic musculoskeletal, or nervous systems. The symptoms of CPPS appear to result from an interplay between psychological factors and dysfunction in the immune, neurological, and endocrine systems. […] CPPS represents a chronic pain syndrome that combines anatomic malfunction of the pelvic floor muscles with malfunction of pain perception linked with psychological and cognitive factors. […] A number of mechanisms have been suggested as the pathophysiological basis of CPPS: (1) An infection process, but no conclusive evidence has been found and antibiotic treatment is ineffective; (2) A neurogenic inflammation that includes local chemical changes; (3) Hypoxia. A disrupted blood flow to the pelvic area, reduced micro-vascular density of the bladder’s submucosa layer, followed by decreased perfusion is supported by clinical improvement following hyperbaric treatment; and (4) Weakness or cramps of the pelvic floor muscles. None of the above have been mentioned as the sole cause of the syndrome, and it is estimated that these mechanisms interact. A common explanation is that, for an unknown reason, the glycosaminoglycan (GAG) layer that coats the mucosa of the bladder and vagina is damaged. This damage leads to a chain of nerve-cell-level processes that culminate in a neurogenic inflammation and mast cell activation.

• #63 New Insights about Chronic Pelvic Pain Syndrome (CPPS)

  https://www.mdpi.com/1660-4601/17/9/3005

  Chronic pelvic pain syndrome (CPPS) is one of the common diseases in urology and gynecology. CPPS is a multifactorial disorder where pain may originate in any of the urogynecological, gastrointestinal, pelvic musculoskeletal, or nervous systems. The symptoms of CPPS appear to result from an interplay between psychological factors and dysfunction in the immune, neurological, and endocrine systems. […] CPPS represents a chronic pain syndrome that combines anatomic malfunction of the pelvic floor muscles with malfunction of pain perception linked with psychological and cognitive factors. […] A number of mechanisms have been suggested as the pathophysiological basis of CPPS: (1) An infection process, but no conclusive evidence has been found and antibiotic treatment is ineffective; (2) A neurogenic inflammation that includes local chemical changes; (3) Hypoxia. A disrupted blood flow to the pelvic area, reduced micro-vascular density of the bladder’s submucosa layer, followed by decreased perfusion is supported by clinical improvement following hyperbaric treatment; and (4) Weakness or cramps of the pelvic floor muscles. None of the above have been mentioned as the sole cause of the syndrome, and it is estimated that these mechanisms interact. A common explanation is that, for an unknown reason, the glycosaminoglycan (GAG) layer that coats the mucosa of the bladder and vagina is damaged. This damage leads to a chain of nerve-cell-level processes that culminate in a neurogenic inflammation and mast cell activation.

• #64 New Insights about Chronic Pelvic Pain Syndrome (CPPS)

  https://www.mdpi.com/1660-4601/17/9/3005

  Chronic pelvic pain syndrome (CPPS) is one of the common diseases in urology and gynecology. CPPS is a multifactorial disorder where pain may originate in any of the urogynecological, gastrointestinal, pelvic musculoskeletal, or nervous systems. The symptoms of CPPS appear to result from an interplay between psychological factors and dysfunction in the immune, neurological, and endocrine systems. […] CPPS represents a chronic pain syndrome that combines anatomic malfunction of the pelvic floor muscles with malfunction of pain perception linked with psychological and cognitive factors. […] A number of mechanisms have been suggested as the pathophysiological basis of CPPS: (1) An infection process, but no conclusive evidence has been found and antibiotic treatment is ineffective; (2) A neurogenic inflammation that includes local chemical changes; (3) Hypoxia. A disrupted blood flow to the pelvic area, reduced micro-vascular density of the bladder’s submucosa layer, followed by decreased perfusion is supported by clinical improvement following hyperbaric treatment; and (4) Weakness or cramps of the pelvic floor muscles. None of the above have been mentioned as the sole cause of the syndrome, and it is estimated that these mechanisms interact. A common explanation is that, for an unknown reason, the glycosaminoglycan (GAG) layer that coats the mucosa of the bladder and vagina is damaged. This damage leads to a chain of nerve-cell-level processes that culminate in a neurogenic inflammation and mast cell activation.

• #65 Chronic Pelvic Pain – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554585/

  Chronic pelvic pain is a persistent or recurrent pain in the lower abdomen or pelvis lasting at least 3 to 6 months. […] The clinical heterogeneity of chronic pelvic pain and its incompletely understood pathogenesis make treatment challenging. […] The pathophysiology of chronic pelvic pain is thought to involve centralized pain mechanisms. Patients with chronic pelvic pain often develop hyperesthesia and allodynia, which are frequently exacerbated by pelvic floor dysfunction. […] Chronic pelvic pain is often secondary to comorbid conditions that cause chronic pain. […] The prolonged nature of this pain increases the risk of central sensitization, contributing to the development of chronic pelvic pain. […] As comorbidities accumulate, the persistence of symptoms promotes central sensitization, further intensifying pain perception.

• #66 EAU Guidelines on Chronic Pelvic Pain – Uroweb

  https://uroweb.org/guidelines/chronic-pelvic-pain/chapter/epidemiology-aetiology-and-pathophysiology

  Over the years much of the focus for CPPPS has been on peripheral-end-organ mechanisms, such as inflammatory or infective conditions. However, both animal and clinical research have indicated that many of the mechanisms for the CPPPSs are based within the CNS. […] Although ongoing peripheral organ pathology can produce persistent and chronic pain, the main focus of these guidelines is on CPPPSs in which no peripheral ongoing pathology (such as infection or neoplastic disease) is detected. The main exception is when pain is due to peripheral nerve damage. […] Risk factors include many different factors from various areas, including genetic, psychological state, recurrent physical trauma and endocrine factors. […] Studies about integrating the psychological factors of CPPPSs are few but the quality is high. Psychological factors are consistently found to be relevant in the maintenance of persistent pelvic and urogenital pain. […] The various mechanisms of CNS facilitation, amplification and failure of inhibition mean that there is no simple relationship between physical findings, pain experience and resulting distress and restriction of activities.

• #67 05. Chronic Pelvic Pain | Hospital Handbook

  https://hospitalhandbook.ucsf.edu/05-chronic-pelvic-pain/05-chronic-pelvic-pain

  Chronic pelvic pain can involve gynecologic, GI, urologic, musculoskeletal, or psychological issues. […] In the absence of a clear single etiology, can be thought of as a complex pain syndrome, with neuromuscular and psychosocial components, requiring a multi-disciplinary approach. […] Differential (most likely): Neuromuscular: Low back/SI joint dysfunction, pelvic floor muscle dysfunction, hip or abdominal wall pathology, hyperesthesia/allodynia, fibromyalgia. […] Initial: Treat known GYN, GI, urologic or psychological issues. […] Medications depending on the type of pain: Neuropathic pain: Treat with centrally acting meds. […] Surgical/procedural: Laparoscopic surgery for endometriosis. […] Continually reassess patient for alternate diagnoses.

• #68 Chronic Pelvic Pain in Women | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0601/p1535.html

  The etiology of chronic pelvic pain in women is poorly understood. Although a specific diagnosis is not found in the majority of cases, some common diagnoses include endometriosis, adhesions, irritable bowel syndrome, and interstitial cystitis. […] The pathophysiology of chronic pelvic pain is not well understood. A definitive diagnosis is not made for 61 percent of women with chronic pelvic pain. Many patients and physicians incorrectly assume that all chronic pelvic pain results from a gynecologic source. One study in the United Kingdom found that diagnoses related to the urinary and gastrointestinal systems were more common than gynecologic diagnoses. The four most commonly diagnosed etiologies are endometriosis, adhesions, irritable bowel syndrome (IBS), and interstitial cystitis. […] Treatment should be directed at the underlying cause of the pelvic pain. Few randomized controlled trials have studied the treatment of chronic pelvic pain. Because different definitions of chronic pelvic pain were used in some of these studies, many treatment recommendations are based on expert opinion or cohort/observational studies.

• #69 Dietary therapy: a new strategy for management of chronic pelvic pain | Nutrition Research Reviews | Cambridge Core

  https://www.cambridge.org/core/journals/nutrition-research-reviews/article/dietary-therapy-a-new-strategy-for-management-of-chronic-pelvic-pain/19E868FB1BE3A08DCFC0D00D7489ACAF

  Chronic pelvic pain (CPP) can be identified as a chronic nociceptive, inflammatory and neuropathic pain characterised by spontaneous pain and an exaggerated response to painful and/or innocuous stimuli. […] Given the complexity and not well-understood aetiology of CPP, its treatment is often unsatisfactory and limited to partial symptom relief. […] There is clear evidence that mechanisms of nociceptive pain are implied in CPP and that peripheral and central sensitisation leads to abnormal perception of both painful and non-painful stimuli contributing to visceral hyperalgesia and allodynia. […] The major evidence for nociceptive pelvic pain as a trigger mechanism for CPP is represented by endometriosis and comes from clinical trials of laparoscopic surgical ablation or excision of endometriotic lesions.

• #70 Molecular mechanism and promising treatments of chronic prostatitis/chronic pelvic pain syndrome: An exploratory bibliometric analysis and literature review of preclinical studies

  https://journal.hep.com.cn/up/EN/10.1002/uro2.34

  As one of the most common diseases in urology, a large number of preclinical studies have been accumulated to explore the etiological mechanism and potential intervention of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). […] According to the results of this study, the most common mechanisms involved in CP/CPPS were as follows: Disturbed immune and inflammation mediators, immune cell dysfunction, oxidative stress, dysregulated signaling pathways, apoptosis, gut microbiota, and testosterone metabolism. […] Traditional Chinese Medicine and extracorporeal shock wave therapy have important potential in the treatment of CP/CPPS. […] Further translational studies targeting the above mechanisms and validating the objective efficacy of potential treatments indicated by preclinical studies in clinical patients are needed in the future.

• #71 Endometriosis-Related Chronic Pelvic Pain

  https://www.mdpi.com/2227-9059/11/10/2868

  Peripheral sensitization is one mechanism that can explain the persistence of pain even without lesions. Nociceptors can become more susceptible to pain after local tissue injury or the inflammatory process, due to neuroplasticity of the peripheral sensory nerve. […] Central sensitization seems to play an important role in converting nociception to chronic pain. Central sensitization is defined as the “increased responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold afferent input.” […] Understanding the mechanism behind this complex condition can aid physicians in better understanding patients and ultimately develop an effective treatment modality to alleviate symptoms of patients who suffer from chronic pelvic pain associated with endometriosis.

• #72 Dietary therapy: a new strategy for management of chronic pelvic pain | Nutrition Research Reviews | Cambridge Core

  https://www.cambridge.org/core/journals/nutrition-research-reviews/article/dietary-therapy-a-new-strategy-for-management-of-chronic-pelvic-pain/19E868FB1BE3A08DCFC0D00D7489ACAF

  So, agents with antioxidant activity are able to improve endometriosis-related symptoms, without undesired prolonged hypo-oestrogenism state effects and any important metabolic change of hormonal suppression therapy. […] Further randomised trials with larger series and long-term follow-up to confirm these observations are needed.

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