The Clinical Significance of Endocannabinoids in Endometriosis Pain Management

Jerome Bouaziz, Alexandra Bar On, Daniel S Seidman, David Soriano, Jerome Bouaziz, Alexandra Bar On, Daniel S Seidman, David Soriano

Abstract

Introduction: Patients with endometriosis often suffer from diffuse and poorly localized severe pain. The current pain management strategies include medical and hormonal therapy, as well as surgery. Medical management of pain is often insufficient and is associated with high rate of recurrence. Better pain management is therefore of urgent need. Methods: Among the various candidates, the endocannabinoid system (ECS) has recently emerged as a relevant pharmacological target for the management of endometriosis-related pain. A computerized literature search was performed to identify relevant studies combining the keywords "endometriosis," "endocannabinoid," "cannabinoid receptor," "THC," and "pain mechanisms." Conclusions: This review describes the multiple and complex pain mechanisms associated with endometriosis. Current data and theories concerning the link between the ECS and pain management for endometriosis patients are presented. Finally, we will discuss which aspects of endometriosis-associated pain can be targeted by modulation of the ECS.

Keywords: cannabis; endocannabinoid; endometriosis; pelvic pain.

Conflict of interest statement

No competing financial interests exist.

Figures

FIG. 1.
FIG. 1.
The different implications of ECS in endometriosis and pain. High levels of CB1 receptors and endocannabinoid ligands have been observed in endometriosis patients. Although this occurs as a mechanism to reduce inflammation, low CB1 levels in the tissue act as a negative feedback loop and disrupt the pain mechanism. However, several natural and synthetic agonists modulate ECS and reduce endometriosis-associated pain. ECS, endocannabinoid system; PEA, N-palmitoylethanolamine.
FIG. 2.
FIG. 2.
ECS interactions with mechanisms of endometriosis pain.

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