Pain Testing in Endometriosis for the Clinician

*John Jarrell*

## **Abstract**

Clinical pain testing has been used to ascertain the pathophysiology of many clinical conditions, but its use in the management of endometriosis has been limited. Although the testing can require the use of complex testing in the laboratory, this chapter is directed to look at a test for allodynia that can be applied in the clinic. The test for cutaneous allodynia is validated, does not require sophisticated tools, and is readily accepted by woman. The presence of allodynia in certain gynecological presentations can indicate the woman's pain system has become sensitized. Uses of the test in clinical encounters with women suffering from endometriosis and possible uses in future are presented.

**Keywords:** pelvic pain, pain testing, pain sensitization, visceral pain, endometriosis

#### **1. Introduction**

The object of this chapter is to introduce and describe pain testing for gynecologists to use at the bedside. Although the subject's description of pain is still the best method of assessing pain, the use of objective pain measures permit independent quantification that is useful in explaining a more complete picture of a disease process, and it is also of help in documenting change in response to medical or surgical intervention. Formal pain testing has now provided new information on the pain mechanisms in chronic pancreatitis, dysmenorrhea, painful bladder syndrome, osteoporosis, and low back pain to name a few conditions [1–5]. Central sensitization has been identified as a component of persistent pelvic pain, with and without endometriosis [3–5]. This summary is intended to provide several examples where testing gives both the woman and the gynecologist a fuller appreciation of the clinical problem of pain.

Clinical pain testing has been used to ascertain the pathophysiology of many clinical conditions, but its use in the management of endometriosis has been limited. Although the testing can require the use of complex testing in the laboratory, this chapter is directed to look at a test for allodynia that can be applied in the clinic. The test for cutaneous allodynia is validated, does not require sophisticated tools, and is readily accepted by woman. The presence of allodynia in certain gynecological presentations can indicate the woman's pain system has become sensitized. Uses of the test in clinical encounters with women suffering from endometriosis and possible uses in future are presented.
