Endometriose en pijn: een overzicht met argumentatie voor een individuele en multidisciplinaire aanpak

Endometriosis and pain: an overview with arguments for an individual and multidisciplinary approach This article provides a narrative overview of endometriosis-related pain. Pain due to endometriosis affects quality of life with an impact on professional, social, family and sexual functioning. Both neuropathic and inflammatory mechanisms are at the root of the pain, which is further modulated via central sensitization in the brain. Chronic pain due to endometriosis is associated with morphological changes in pain-processing areas of the central nervous system. These data reinforce the need to frame endometriosis therapy in a much broader sense than just local surgical removal and (hormonal) suppression. Both the diagnosis and the therapy of endometriosis benefit from a multidisciplinary and dedicated team. The literature on the treatment of endometriosis-related pain is characterized by large gaps, there are only a few prospective randomized or placebo-controlled studies. In addition to surgery, estrogestin combinations, progestogens alone, GnRH agonists and antagonists, aromatase inhibitors, selective estrogen and/or progestogen receptor modulators, NSAIDs (non-steroidal anti-inflammatory drugs), psychotherapy and physiotherapy can be used. Except for acupuncture, there are no good comparative studies on alternative treatments, like for example certain nutritional supplements, cannabis, osteopathy and other alternatives. In view of the interdependence of pain complaints in endometriosis patients and its effects on their social and personal experience and functioning, the approach must be based on a patient-oriented program, adapted to the personal needs and preferences of the patient. A multidisciplinary approach with a policy based on the needs and expectations of the patient can be an added value.