Endometriozis Patogenezi
Synopsis
Endometriozis, dünya çapında üreme çağındaki kadınların %10'unu etkileyen kronik yaygın bir durumdur. Rahim dışındaki anormal bölgelerde endometriyum benzeri dokunun büyümesi ile karakterize olan bu hastalık, kadınların yaşam kalitesini önemli ölçüde düşüren kronik pelvik ağrı, dismenore ve subfertilite gibi semptomlardan sorumludur. Patogenezi farklı teoriler tarafından desteklenmektedir. Biriken gerçekler onu multigenik bir bozuklukla ilişkilendirir.
Endometriosis is a chronic common condition affecting 10% of reproductive-aged women globally. Characterized by the growth of endometrium-like tissue in aberrant locations outside of the uterus, it is responsible for symptoms including chronic pelvic pain, dysmenorrhea, and subfertility that degrade quality of life of women significantly. Its pathogenesis is supported by different theories. Accumulating facts relate it to a multigenic disorder.
References
Sampson, J. A. Peritoneal endometriosis due to premenstrual dissemination of endometrial tissue into the peritoneal cavity. Am. J. Obstet. Gynecol. 14, 422–469 (1927).
Giudice, L. C. & Kao, L. C. Endometriosis. Lancet 364, 1789–1799 (2004).
Berkley, K. J., Rapkin, A. J. & Papka, R. E. The pains of endometriosis. Science 308, 1587–1589 (2005).
de Ziegler, D., Borghese, B. & Chapron, C. Endometriosis and infertility: pathophysiology and management. Lancet 376, 730–738 (2010).
EHurd, W. W. Criteria that indicate endometriosis is the cause of chronic pelvic pain. Obstet. Gynecol. 92, 1029–1032 (1998).
Giudice LC. Clinical practice. Endometriosis. N Engl J Med 2010; 362:2389.
Rahmioglu N, Nyholt DR, Morris AP, et al. Genetic variants underlying risk of endometriosis: insights from meta-analysis of eight genome-wide association and replication datasets. Hum Reprod Update 2014; 20:702.
Anglesio MS, Papadopoulos N, Ayhan A, et al. Cancer-Associated Mutations in Endometriosis without Cancer. N Engl J Med 2017; 376:1835.
Bulun SE, Wan Y, Matei D. Epithelial Mutations in Endometriosis: Link to Ovarian Cancer. Endocrinology 2019; 160:626.
Stefansson, H. et al. Genetic factors contribute to the risk of developing endometriosis. Hum. Reprod. 17, 555–559 (2002).
Treloar, S. A., O'Connor, D. T., O'Connor, V. M. & Martin, N. G. Genetic influences on endometriosis in an Australian twin sample. Fertil. Steril. 71, 701–710 (1999).
Saha, R. et al. Heritability of endometriosis. Fertil. Steril. 104, 947–952 (2015).
Rahmioglu, N., Missmer, S. A., Montgomery, G. W.& Zondervan, K. T. Insights into assessing the genetics of endometriosis. Curr. Obstet. Gynecol. Rep. 1, 124–137 (2012).
Rahmioglu, N., Montgomery, G. W. & Zondervan, K. T. Genetics of endometriosis. Womens Health 11, 577–586 (2015).
Treloar, S. et al. The international endogene study: a collection of families for genetic research in endometriosis. Fertil. Steril. 78, 679–685 (2002).
Treloar, S. A. et al. Genomewide linkage study in 1,176 affected sister pair families identifies a significant susceptibility locus for endometriosis on chromosome 10q26. Am. J. Hum. Genet. 77, 365–376 (2005).
Zondervan, K. T. et al. Significant evidence of one or more susceptibility loci for endometriosis with near-Mendelian inheritance on chromosome 7p13-15. Hum. Reprod. 22, 717–728 (2007).
Borghese, B., Zondervan, K. T., Abrao, M. S.,Chapron, C. & Vaiman, D. Recent insights on the genetics and epigenetics of endometriosis. Clin. Genet. 91, 254–264 (2017).
Vercellini, P., Vigano, P., Somigliana, E. & Fedele, L. Endometriosis: pathogenesis and treatment. Nat. Rev. Endocrinol. 10, 261–275 (2014).
Chapron, C. et al. Deeply infiltrating endometriosis: pathogenetic implications of the anatomical distribution. Hum. Reprod. 21, 1839–1845 (2006).
Bricou, A., Batt, R. E. & Chapron, C. Peritoneal fluid flow influences anatomical distribution of endometriotic lesions: why Sampson seems to be right. Eur. J. Obstet. Gynecol. Reprod. Biol. 138, 127–134 (2008).
Kirschner, P. A. Porous diaphragm syndromes. Chest Surg. Clin. N. Am. 8, 449–472 (1998).
Vercellini P, Viganò P, Somigliana E, Fedele L. Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol 2014; 10:261.
Sampson, J. A. Peritoneal endometriosis due to premenstrual dissemination of endometrial tissue into the peritoneal cavity. Am. J. Obstet. Gynecol. 14, 422–469 (1927).
Vannuccini, S. et al. Potential influence of in utero and early neonatal exposures on the later development of endometriosis. Fertil. Steril. 105, 997–1002 (2016).
Vercellini, P., Vigano, P., Somigliana, E. & Fedele, L. Endometriosis: pathogenesis and treatment. Nat. Rev. Endocrinol. 10, 261–275 (2014).
Chapron, C. et al. Deeply infiltrating endometriosis: pathogenetic implications of the anatomical distribution. Hum. Reprod. 21, 1839–1845 (2006).
Bricou, A., Batt, R. E. & Chapron, C. Peritoneal fluid flow influences anatomical distribution of endometriotic lesions: why Sampson seems to be right. Eur. J. Obstet. Gynecol. Reprod. Biol. 138, 127–134 (2008).
Kirschner, P. A. Porous diaphragm syndromes. Chest Surg. Clin. N. Am. 8, 449–472 (1998).
Batt, R. E. et al. Mullerianosis. Histol. Histopathol. 22, 1161–1166 (2007).
Batt, R. E. & Yeh, J. Mullerianosis: four developmental (embryonic) mullerian diseases. Reprod. Sci. 20, 1030–1037 (2013).
Hufnagel, D., Li, F., Cosar, E., Krikun, G. & Taylor, H. S. The role of stem cells in the etiology and pathophysiology of endometriosis. Semin. Reprod. Med. 33, 333–340 (2015).
Jerman, L. F. & Hey-Cunningham, A. J. The role of the lymphatic system in endometriosis: a comprehensive review of the literature. Biol. Reprod. 92, 64 (2015).
Zondervan, K. T. et al. Endometriosis. Nat. Rev. Dis. Prim. 4, 9 (2018).
Samani, E. N. et al. Micrometastasis of endometriosis to distant organs in a murine model. Oncotarget 10, 2282–2291 (2019).
Bulun, S. E. Endometriosis. N. Engl J. Med. 360, 268–279 (2009).
Reis, F. M., Petraglia, F. & Taylor, R. N. Endometriosis: hormone regulation and clinical consequences of chemotaxis and apoptosis. Hum. Reprod. Update 19, 406–418 (2013).
Chapron, C., Marcellin, L., Borghese, B., & Santulli, P. (2019). Rethinking mechanisms, diagnosis and management of endometriosis. Nature reviews. Endocrinology, 15(11), 666–682. https://doi.org/10.1038/s41574-019-0245-z
Burney RO, Giudice LC. Pathogenesis and pathophysiology of endometriosis. Fertil Steril 2012; 98:511.
Du H, Taylor HS. Contribution of bone marrow-derived stem cells to endometrium and endometriosis. Stem Cells 2007; 25:2082.
Longo LD. Classic pages in obstetrics and gynecology. Aberrant portions of the müllerian duct found in an ovary: William Wood Russell Johns Hopkins Hospital Bulletin, vol. 10, pp. 8--10, 1899. Am J Obstet Gynecol 1979; 134:225.
JAVERT CT. The spread of benign and malignant endometrium in the lymphatic system with a note on coexisting vascular involvement. Am J Obstet Gynecol 1952; 64:780.
Halban, J. Hysteroadenosis metastica. Wien Klin Wochenschr 1924; 37:1205.
Gruenwald P. Origin of endometriosis from the mesenchyme of the celomic walls. Am J Obstet Gynecol 1942; 44:470.
Meyer, R. Uber entzundliche neterope epithelwucherungen im weiblichen Genetalg ebiet und uber eine bis in die Wurzel des Mesocolon ausgedehnte benigne Wucherung des Dar mepithel. Virch Arch Pathol Anat 1909; 195:487.
Gleicher N, el-Roeiy A, Confino E, Friberg J. Is endometriosis an autoimmune disease? Obstet Gynecol 1987; 70:115.
Dmowski WP, Braun D, Gebel H. Endometriosis: genetic and immunologic aspects. Prog Clin Biol Res 1990; 323:99.
Nothnick WB. Treating endometriosis as an autoimmune disease. Fertil Steril 2001; 76:223.
Marsh EE, Laufer MR. Endometriosis in premenarcheal girls who do not have an associated obstructive anomaly. Fertil Steril 2005; 83:758.
Brosens I, Puttemans P, Benagiano G. Endometriosis: a life cycle approach? Am J Obstet Gynecol 2013; 209:307.
Oliveira FR, Dela Cruz C, Del Puerto HL, et al. Stem cells: are they the answer to the puzzling etiology of endometriosis? Histol Histopathol 2012; 27:23.
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Dekker J, Hooijer I, Ket JCF, et al. Neonatal Uterine Bleedings: An Ignored Sign but a Possible Cause of Early-Onset Endometriosis - A Systematic Review. Biomed Hub 2021; 6:6.
Brosens I, Benagiano G. Is neonatal uterine bleeding involved in the pathogenesis of endometriosis as a source of stem cells? Fertil Steril 2013; 100:622.
Anaf V, Simon P, El Nakadi I, et al. Relationship between endometriotic foci and nerves in rectovaginal endometriotic nodules. Hum Reprod 2000; 15:1744.
Wang G, Tokushige N, Markham R, Fraser IS. Rich innervation of deep infiltrating endometriosis. Hum Reprod 2009; 24:827.
Tran LV, Tokushige N, Berbic M, et al. Macrophages and nerve fibres in peritoneal endometriosis. Hum Reprod 2009; 24:835.
Matsuzaki S, Darcha C. Involvement of the Wnt/β-catenin signaling pathway in the cellular and molecular mechanisms of fibrosis in endometriosis. PLoS One 2013; 8:e76808.
McKinnon BD, Bertschi D, Bersinger NA, Mueller MD. Inflammation and nerve fiber interaction in endometriotic pain. Trends Endocrinol Metab 2015; 26:1.
Mechsner S, Kaiser A, Kopf A, et al. A pilot study to evaluate the clinical relevance of endometriosis-associated nerve fibers in peritoneal endometriotic lesions. Fertil Steril 2009; 92:1856.
Arnold J, Barcena de Arellano ML, Rüster C, et al. Imbalance between sympathetic and sensory innervation in peritoneal endometriosis. Brain Behav Immun 2012; 26:132.
Arnold J, Vercellino GF, Chiantera V, et al. Neuroimmunomodulatory alterations in non-lesional peritoneum close to peritoneal endometriosis. Neuroimmunomodulation 2013; 20:9.
Liang Y, Yao S. Potential role of estrogen in maintaining the imbalanced sympathetic and sensory innervation in endometriosis. Mol Cell Endocrinol 2016; 424:42.
Wheeler MA, Heffner DL, Kim S, et al. TNF-α/TNFR1 signaling is required for the development and function of primary nociceptors. Neuron 2014; 82:587.
As-Sanie S, Harris RE, Napadow V, et al. Changes in regional gray matter volume in women with chronic pelvic pain: a voxel-based morphometry study. Pain 2012; 153:1006.
McKinnon, B. D., Bertschi, D., Bersinger, N. A. & Mueller, M. D. Inflammation and nerve fiber interaction in endometriotic pain. Trends Endocrinol. Metab. 26, 1–10 (2015).
Anaf, V. et al. Pain, mast cells, and nerves in peritoneal, ovarian, and deep infiltrating endometriosis. Fertil. Steril.1336–1343 (2006).
Anaf, V. et al. Relationship between endometriotic foci and nerves in rectovaginal endometriotic nodules. Hum. Reprod. 15, 1744–1750 (2000).
McKinnon, B. D., Kocbek, V., Nirgianakis, K., Bersinger, N. A. & Mueller, M. D. Kinase signalling pathways in endometriosis: potential targets for non- hormonal therapeutics. Hum. Reprod. Update 22, 382–403 (2016).
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As- Sanie, S. et al. Changes in regional gray matter volume in women with chronic pelvic pain: a voxel- based morphometry study. Pain 153, 1006–1014 (2012).
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Giudice, L. C. & Kao, L. C. Endometriosis. Lancet 364, 1789–1799 (2004).
Berkley, K. J., Rapkin, A. J. & Papka, R. E. The pains of endometriosis. Science 308, 1587–1589 (2005).
de Ziegler, D., Borghese, B. & Chapron, C. Endometriosis and infertility: pathophysiology and management. Lancet 376, 730–738 (2010).
EHurd, W. W. Criteria that indicate endometriosis is the cause of chronic pelvic pain. Obstet. Gynecol. 92, 1029–1032 (1998).
Giudice LC. Clinical practice. Endometriosis. N Engl J Med 2010; 362:2389.
Rahmioglu N, Nyholt DR, Morris AP, et al. Genetic variants underlying risk of endometriosis: insights from meta-analysis of eight genome-wide association and replication datasets. Hum Reprod Update 2014; 20:702.
Anglesio MS, Papadopoulos N, Ayhan A, et al. Cancer-Associated Mutations in Endometriosis without Cancer. N Engl J Med 2017; 376:1835.
Bulun SE, Wan Y, Matei D. Epithelial Mutations in Endometriosis: Link to Ovarian Cancer. Endocrinology 2019; 160:626.
Stefansson, H. et al. Genetic factors contribute to the risk of developing endometriosis. Hum. Reprod. 17, 555–559 (2002).
Treloar, S. A., O'Connor, D. T., O'Connor, V. M. & Martin, N. G. Genetic influences on endometriosis in an Australian twin sample. Fertil. Steril. 71, 701–710 (1999).
Saha, R. et al. Heritability of endometriosis. Fertil. Steril. 104, 947–952 (2015).
Rahmioglu, N., Missmer, S. A., Montgomery, G. W.& Zondervan, K. T. Insights into assessing the genetics of endometriosis. Curr. Obstet. Gynecol. Rep. 1, 124–137 (2012).
Rahmioglu, N., Montgomery, G. W. & Zondervan, K. T. Genetics of endometriosis. Womens Health 11, 577–586 (2015).
Treloar, S. et al. The international endogene study: a collection of families for genetic research in endometriosis. Fertil. Steril. 78, 679–685 (2002).
Treloar, S. A. et al. Genomewide linkage study in 1,176 affected sister pair families identifies a significant susceptibility locus for endometriosis on chromosome 10q26. Am. J. Hum. Genet. 77, 365–376 (2005).
Zondervan, K. T. et al. Significant evidence of one or more susceptibility loci for endometriosis with near-Mendelian inheritance on chromosome 7p13-15. Hum. Reprod. 22, 717–728 (2007).
Borghese, B., Zondervan, K. T., Abrao, M. S.,Chapron, C. & Vaiman, D. Recent insights on the genetics and epigenetics of endometriosis. Clin. Genet. 91, 254–264 (2017).
Vercellini, P., Vigano, P., Somigliana, E. & Fedele, L. Endometriosis: pathogenesis and treatment. Nat. Rev. Endocrinol. 10, 261–275 (2014).
Chapron, C. et al. Deeply infiltrating endometriosis: pathogenetic implications of the anatomical distribution. Hum. Reprod. 21, 1839–1845 (2006).
Bricou, A., Batt, R. E. & Chapron, C. Peritoneal fluid flow influences anatomical distribution of endometriotic lesions: why Sampson seems to be right. Eur. J. Obstet. Gynecol. Reprod. Biol. 138, 127–134 (2008).
Kirschner, P. A. Porous diaphragm syndromes. Chest Surg. Clin. N. Am. 8, 449–472 (1998).
Vercellini P, Viganò P, Somigliana E, Fedele L. Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol 2014; 10:261.
Sampson, J. A. Peritoneal endometriosis due to premenstrual dissemination of endometrial tissue into the peritoneal cavity. Am. J. Obstet. Gynecol. 14, 422–469 (1927).
Vannuccini, S. et al. Potential influence of in utero and early neonatal exposures on the later development of endometriosis. Fertil. Steril. 105, 997–1002 (2016).
Vercellini, P., Vigano, P., Somigliana, E. & Fedele, L. Endometriosis: pathogenesis and treatment. Nat. Rev. Endocrinol. 10, 261–275 (2014).
Chapron, C. et al. Deeply infiltrating endometriosis: pathogenetic implications of the anatomical distribution. Hum. Reprod. 21, 1839–1845 (2006).
Bricou, A., Batt, R. E. & Chapron, C. Peritoneal fluid flow influences anatomical distribution of endometriotic lesions: why Sampson seems to be right. Eur. J. Obstet. Gynecol. Reprod. Biol. 138, 127–134 (2008).
Kirschner, P. A. Porous diaphragm syndromes. Chest Surg. Clin. N. Am. 8, 449–472 (1998).
Batt, R. E. et al. Mullerianosis. Histol. Histopathol. 22, 1161–1166 (2007).
Batt, R. E. & Yeh, J. Mullerianosis: four developmental (embryonic) mullerian diseases. Reprod. Sci. 20, 1030–1037 (2013).
Hufnagel, D., Li, F., Cosar, E., Krikun, G. & Taylor, H. S. The role of stem cells in the etiology and pathophysiology of endometriosis. Semin. Reprod. Med. 33, 333–340 (2015).
Jerman, L. F. & Hey-Cunningham, A. J. The role of the lymphatic system in endometriosis: a comprehensive review of the literature. Biol. Reprod. 92, 64 (2015).
Zondervan, K. T. et al. Endometriosis. Nat. Rev. Dis. Prim. 4, 9 (2018).
Samani, E. N. et al. Micrometastasis of endometriosis to distant organs in a murine model. Oncotarget 10, 2282–2291 (2019).
Bulun, S. E. Endometriosis. N. Engl J. Med. 360, 268–279 (2009).
Reis, F. M., Petraglia, F. & Taylor, R. N. Endometriosis: hormone regulation and clinical consequences of chemotaxis and apoptosis. Hum. Reprod. Update 19, 406–418 (2013).
Chapron, C., Marcellin, L., Borghese, B., & Santulli, P. (2019). Rethinking mechanisms, diagnosis and management of endometriosis. Nature reviews. Endocrinology, 15(11), 666–682. https://doi.org/10.1038/s41574-019-0245-z
Burney RO, Giudice LC. Pathogenesis and pathophysiology of endometriosis. Fertil Steril 2012; 98:511.
Du H, Taylor HS. Contribution of bone marrow-derived stem cells to endometrium and endometriosis. Stem Cells 2007; 25:2082.
Longo LD. Classic pages in obstetrics and gynecology. Aberrant portions of the müllerian duct found in an ovary: William Wood Russell Johns Hopkins Hospital Bulletin, vol. 10, pp. 8--10, 1899. Am J Obstet Gynecol 1979; 134:225.
JAVERT CT. The spread of benign and malignant endometrium in the lymphatic system with a note on coexisting vascular involvement. Am J Obstet Gynecol 1952; 64:780.
Halban, J. Hysteroadenosis metastica. Wien Klin Wochenschr 1924; 37:1205.
Gruenwald P. Origin of endometriosis from the mesenchyme of the celomic walls. Am J Obstet Gynecol 1942; 44:470.
Meyer, R. Uber entzundliche neterope epithelwucherungen im weiblichen Genetalg ebiet und uber eine bis in die Wurzel des Mesocolon ausgedehnte benigne Wucherung des Dar mepithel. Virch Arch Pathol Anat 1909; 195:487.
Gleicher N, el-Roeiy A, Confino E, Friberg J. Is endometriosis an autoimmune disease? Obstet Gynecol 1987; 70:115.
Dmowski WP, Braun D, Gebel H. Endometriosis: genetic and immunologic aspects. Prog Clin Biol Res 1990; 323:99.
Nothnick WB. Treating endometriosis as an autoimmune disease. Fertil Steril 2001; 76:223.
Marsh EE, Laufer MR. Endometriosis in premenarcheal girls who do not have an associated obstructive anomaly. Fertil Steril 2005; 83:758.
Brosens I, Puttemans P, Benagiano G. Endometriosis: a life cycle approach? Am J Obstet Gynecol 2013; 209:307.
Oliveira FR, Dela Cruz C, Del Puerto HL, et al. Stem cells: are they the answer to the puzzling etiology of endometriosis? Histol Histopathol 2012; 27:23.
Figueira PG, Abrão MS, Krikun G, Taylor HS. Stem cells in endometrium and their role in the pathogenesis of endometriosis. Ann N Y Acad Sci 2011; 1221:10.
Dekker J, Hooijer I, Ket JCF, et al. Neonatal Uterine Bleedings: An Ignored Sign but a Possible Cause of Early-Onset Endometriosis - A Systematic Review. Biomed Hub 2021; 6:6.
Brosens I, Benagiano G. Is neonatal uterine bleeding involved in the pathogenesis of endometriosis as a source of stem cells? Fertil Steril 2013; 100:622.
Anaf V, Simon P, El Nakadi I, et al. Relationship between endometriotic foci and nerves in rectovaginal endometriotic nodules. Hum Reprod 2000; 15:1744.
Wang G, Tokushige N, Markham R, Fraser IS. Rich innervation of deep infiltrating endometriosis. Hum Reprod 2009; 24:827.
Tran LV, Tokushige N, Berbic M, et al. Macrophages and nerve fibres in peritoneal endometriosis. Hum Reprod 2009; 24:835.
Matsuzaki S, Darcha C. Involvement of the Wnt/β-catenin signaling pathway in the cellular and molecular mechanisms of fibrosis in endometriosis. PLoS One 2013; 8:e76808.
McKinnon BD, Bertschi D, Bersinger NA, Mueller MD. Inflammation and nerve fiber interaction in endometriotic pain. Trends Endocrinol Metab 2015; 26:1.
Mechsner S, Kaiser A, Kopf A, et al. A pilot study to evaluate the clinical relevance of endometriosis-associated nerve fibers in peritoneal endometriotic lesions. Fertil Steril 2009; 92:1856.
Arnold J, Barcena de Arellano ML, Rüster C, et al. Imbalance between sympathetic and sensory innervation in peritoneal endometriosis. Brain Behav Immun 2012; 26:132.
Arnold J, Vercellino GF, Chiantera V, et al. Neuroimmunomodulatory alterations in non-lesional peritoneum close to peritoneal endometriosis. Neuroimmunomodulation 2013; 20:9.
Liang Y, Yao S. Potential role of estrogen in maintaining the imbalanced sympathetic and sensory innervation in endometriosis. Mol Cell Endocrinol 2016; 424:42.
Wheeler MA, Heffner DL, Kim S, et al. TNF-α/TNFR1 signaling is required for the development and function of primary nociceptors. Neuron 2014; 82:587.
As-Sanie S, Harris RE, Napadow V, et al. Changes in regional gray matter volume in women with chronic pelvic pain: a voxel-based morphometry study. Pain 2012; 153:1006.
McKinnon, B. D., Bertschi, D., Bersinger, N. A. & Mueller, M. D. Inflammation and nerve fiber interaction in endometriotic pain. Trends Endocrinol. Metab. 26, 1–10 (2015).
Anaf, V. et al. Pain, mast cells, and nerves in peritoneal, ovarian, and deep infiltrating endometriosis. Fertil. Steril.1336–1343 (2006).
Anaf, V. et al. Relationship between endometriotic foci and nerves in rectovaginal endometriotic nodules. Hum. Reprod. 15, 1744–1750 (2000).
McKinnon, B. D., Kocbek, V., Nirgianakis, K., Bersinger, N. A. & Mueller, M. D. Kinase signalling pathways in endometriosis: potential targets for non- hormonal therapeutics. Hum. Reprod. Update 22, 382–403 (2016).
Woolf, C. J. Central sensitization: implications for the diagnosis and treatment of pain. Pain 152, S2–S15 (2011).
Aredo, J. V., Heyrana, K. J., Karp, B. I., Shah, J. P. & Stratton, P. Relating chronic pelvic pain and endometriosis to signs of sensitization and myofascial pain and dysfunction. Semin. Reprod. Med. 35, 88–97 (2017).
Hoffman, D. Central and peripheral pain generators in women with chronic pelvic pain: patient centered assessment and treatment. Curr. Rheumatol. Rev. 11, 146–166 (2015).
Woolf, C. J. & Salter, M. W. Neuronal plasticity: increasing the gain in pain. Science 288, 1765–1769 (2000).
As- Sanie, S. et al. Changes in regional gray matter volume in women with chronic pelvic pain: a voxel- based morphometry study. Pain 153, 1006–1014 (2012).
As- Sanie, S. et al. Functional connectivity is associated with altered brain chemistry in women with endometriosis- associated chronic pelvic pain. J. Pain. 17, 1–13 (2016).
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Pages
17-24
Published
January 21, 2025
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