The Impact of Targeted Endometriosis Treatment On Patients with Central Sensitization: Systematic Review and Meta Analysis

Objective: Central sensitization (CSS), a condition where the central nervous system amplifies pain signals, may impact response to treatment of chronic pain conditions. The objective of this study is to determine if CSS affects outcomes after medical or surgical treatment for women with endometriosis via a systematic review and meta-analysis. Data Sources: A systematic literature search using MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Review, Science Citation Index Expanded, and Emerging Sources Citation Index was conducted without language or date restrictions. The search strategy utilized MeSH and EMTREE terms to capture concepts related to central sensitization, endometriosis, and associated symptoms like dysmenorrhea. Interventions in the reviewed studies included medical treatment or surgery. Methods of Study Selection: Studies reporting on endometriosis outcomes in women with and wihout CSS were included in the review. We excluded studies which primarily focused on non-endometriosis pelvic pain syndromes. A total of 1821 abstracts were identified, and 259 full texts were reviewed for eligibility. Five studies met inclusion criteria encompassing a total of 1271 patients. Data for meta-analysis was not available for one study and another study was excluded as it was the only one describing medical treatment. The Newcastle-Ottawa scale was used to assess quality and risk of bias. Results were sythesized using random effect meta-anlayses to estimate the pooled risk ratio (RR) and 95% confience using the DerSimmonian and Laird methods. Tabulation, Integration, and Results: The percentage of patients with CSS ranged from 28.3% to 80.2%. Patients with CSS have smaller changes in pain scores after endometriosis surgery (RR 0.79, confidence interval 0.73–0.86) and significantly higher persistent pain (RR 2.27, confidence interval 1.40–3.68). Conclusion: Higher baseline catastrophization is associated with worse outcomes in women undergoing treatment for endometriosis. This is important to consider during counseling and decision-making.