Clinical Importance of Pain Sensitization in Gynecology

Peripheral and central sensitizations are conditions of the nervous system that are characterized by increased tone and responsiveness, a lower threshold for the experience of pain and a tendency for pain to persist long after the original stimulus has ended [1]. The mechanism of the development of chronicity is under intense investigation involving a variety of important biochemical and sensitization processes. From a clinical perspective however, the situation can be summed up that pain per se, if not kept under control, may initiate the processes causing the transition from acute to chronic pain.

Basic Investigations

Investigations into the origins of central sensitization in particular, have focused on the role of continuous peripheral drive from the nociceptors (defined as neurons that are activated by noxious stimulation). It has been shown these nociceptors can become sensitized after being injured and develop a lower threshold for activation. Further, the persistence of afferent stimulation and neuronal firing continuously activate the dorsal horn nuclei of the spinal cord and thereby cause central sensitization by e. g. long-term potentiation and neuronal phenotype reorganization. Thus, the central nervous system has the capacity to modify the pain experience such that it can be more or less dependent of the peripheral state, but generally chronic pain patients have some degree of sensitization [2]. There is a disconnection in the relationship of stimulus to response [2] as seen in many chronic conditions where there is a disconnect between pain intensity and size of injure e.g. degree of joint damage in osteoarthritis, size of ulcer, degree of nerve damage and extend of endometriosis [3].

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