Prevalence of neuropathic pain in women with chronic pelvic pain: systematic review

Nogueira-Neto, João; Camapum, Luiz Fernando Carvalho; Lira, Lyrian Lorena Freire; Camapum, Dara Maria Sá Rêgo; Gomes, Lyvia Maria Rodrigues de Sousa; Leal, Plínio da Cunha

doi:10.63231/2595-0118.202675-en

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REVIEW ARTICLE • BrJP 9 • 2026 • https://doi.org/10.63231/2595-0118.202675-en linkcopy

Prevalence of neuropathic pain in women with chronic pelvic pain: systematic review

Prevalência de dor neuropática em mulheres com dor pélvica crônica: revisão sistemática

Authorship SCIMAGO INSTITUTIONS RANKINGS

BACKGROUND AND OBJECTIVES Chronic pelvic pain (CPP) in women is a multifactorial condition frequently associated with neuropathic mechanisms, but the prevalence of neuropathic pain (NP) in this population remains uncertain. The aim of this study was to systematically quantify the prevalence of NP in women diagnosed with CPP, using validated screening tools.

CONTENTS This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in the Prospective International Registry of Systematic Reviews (PROSPERO), ID no. CRD42024593980. The search for articles was performed on the CINAHL (Cumulative Index to Nursing and Allied Health Literature), Embase, Pubmed, Scielo, SportDiscus, Web of Science, and Google Scholar platforms and covered studies published between 2010 and 2024. The eight studies included 989 women with CPP and reported NP prevalence ranging from 13.6% to 66.0%. The prevalence estimates varied depending on the instrument used: 31.0%-64.8% (S-LANSS), 35.0%-66.0% (DN4), and 13.6%-31.7% (painDETECT). Sample-size-weighted mean prevalences were 45.9% for S-LANSS, 44.3% for DN4 and 28.8% for painDETECT. NP in women with CPP was also associated with lower quality of life, greater psychological distress, cognitive alterations, endometriosis, provoked vestibulodynia, vulvodynia and greater genitourinary pain severity.

CONCLUSION NP is highly prevalent in women with CPP, underscoring the importance of routine screening for its neuropathic component in clinical practice. Further research is warranted, given the limited number of studies that comprehensively address this relation.

Keywords:
Chronic pain; Neuralgia; Neuropathic pain; Pelvic pain

Neuropathic pain is highly prevalent in women with chronic pelvic pain, with mean prevalence of 45.9% for S-LANSS, 44.3% for DN4 and 28.8% for painDETECT

In women with chronic pelvic pain, neuropathic pain is associated with poorer quality of life, greater psychological distress and cognitive alterations

Routine identification of the neuropathic component in chronic pelvic pain can guide more effective therapeutic strategies

Authors	Year	Type of study	Location	Objectives
Whitaker et al.⁷	2014	Exploratory Prospective Cohort	United Kingdom	To determine whether women with CPP have a NP component to their pain symptoms, and how this can best be assessed. To assess the correlation between different NP questionnaires in women with CPP. To determine the acceptability of the different questionnaires in patients with CPP.
Coxon et al.⁸	2023	Exploratory Prospective Cohort	United Kingdom, United States of America, Portugal	To evaluate sensory phenotypes in women with CPP using QST developed by DFNS.
Itza et al.¹³	2012	Case-control study	Spain	To validate the turns-amplitude analysis as a diagnostic test for pelvic floor myofascial syndrome in patients with CPP. To evaluate whether the diagnostic test can identify neuropathic features in patients with CPP.
George et al.¹⁴	2012	Exploratory Prospective Cohort	United States of America	To assess the quality of life of patients with CPP in relation to the presence of neuropathic symptoms.
Tersiguel et al.¹⁵	2021	Cross‑sectional study	France	To investigate the presence of a neuropathic component in the pathogenesis of vulvodynia in women with CPP. To determine the presence of anxiety, depression and other chronic pain conditions in patients with vulvodynia.
Dargie et al.¹⁶	2017	Cross-sectional study	Online research without geographical restrictions	To identify self-reported NP characteristics in women with provoked vulvar pain using the S-LANSS, NPSI and PQAS questionnaires.
Bouko-Levy et al.¹⁷	2024	Retrospective Cohort	France	Examine the prevalence of neuropathic pain in women with symptomatic endometriosis, and explore the factors associated with this type of pain.
Schrepf et al.¹⁸	2022	Multicenter retrospective cross‑sectional study	MAPP research network	Evaluate whether UCPPS is a predominantly nociceptive condition, and which pain mechanisms contribute to this condition.

Authors	Sample	Age (years) Mean±SD [Range]	Questionnaires			Conclusions
Authors	Sample	Age (years) Mean±SD [Range]	S-LANSS	DN4	PainDETECT	Conclusions
Whitaker et al.⁷	72	34.00±8.85 [20-54]	56.0%	35.0%	26.0%	NP is an important component of CPP, regardless of associated pelvic disease. The agreement between questionnaires was moderate, suggesting that multiple instruments may be necessary for a comprehensive assessment. The painDETECT and S-LANSS questionnaires were rated as favorable in 93% and 89% of patients, respectively, demonstrating high acceptability.
Coxon et al.⁸	59	35.57 [20-51]	-	-	13.6%	There are significant changes in somatosensory function in women with CPP, with 6.8% of patients presenting a healthy sensory profile (sensation similar to that of the pain-free population).
Itza et al.¹³	32	45.69±14.65 [NR]	-	56.7%	-	The study demonstrated that the range of rotation test is reliable for diagnosing pelvic floor myofascial pain syndrome. Based on the data obtained by the questionnaire, there is a higher prevalence of NP in women with CPP.
George et al.¹⁴	132	45.00 [14-82]	31.0%	-	-	Patients with CPP and neuropathic symptoms report worse quality of life compared to the general population.
Tersiguel et al.¹⁵	15	44.00 [20-74]	-	66.0%	-	From DN4 onwards, 66% of patients with vulvodynia presented a neuropathic component, i.e., neuropathy plays an important role in the pathogenesis of vulvodynia. There is a higher prevalence of psychological distress experienced by patients with CPP and NP.
Dargie et al.¹⁶	65	36.46±13.79 [NR]	64.8%	-	-	A significant proportion of women with provoked vulvar pain had features of NP, suggesting a significant neuropathic component in this condition.
Bouko-Levy et al.¹⁷	236	32.6±7.76 [NR]	-	44.1%	-	Younger age, being in a relationship, having a high EPH-5 score and undergoing laparoscopy for endometriosis are associated with neuropathic pain independently of other variables.
Schrepf et al.¹⁸	378	44.87±15.68 [NR]	-	-	31.7%	Neuropathic pain was associated with genital pain and/or sensitivity on pelvic exam, while nociplastic pain was associated with comorbid pain conditions, psychosocial difficulties, and increased pressure pain sensitivity outside the pelvis.

Questions	Whitaker et al. ⁷	Coxon et al. ⁸	Itza et al. ¹³	George et al. ¹⁴	Tersiguel et al. ¹⁵	Dargie et al. ¹⁶	Bouko-Levy et al. ¹⁷	Schrepf et al. ¹⁸
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[1] CPP = Chronic Pelvic Pain; NP = Neuropathic Pain; QST = Quantitative Sensory Testing; DFNS = German Research Network on Neuropathic Pain; S-LANSS = Self-Report Leeds Assessment of Neuropathic Symptoms and Signs; NPSI = Neuropathic Pain Symptom Inventory; PQAS = Pain Quality Assessment Scale; MAPP = Multidisciplinary Approach to the Study of Chronic Pelvic Pain; UCPPS = Urologic Chronic Pelvic Pain Syndrome.