Standardizing medical pain management for the endometriosis patient: A Dutch modified eDelphi procedure.
| Title: | Standardizing medical pain management for the endometriosis patient: A Dutch modified eDelphi procedure. |
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| Authors: | van Haaps AP; Department of Gynaecology, Academic Endometriosis Centre, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam University Medical Centers, Amsterdam, the Netherlands. Electronic address: a.vanhaaps@amsterdamumc.nl.; Schreurs AMF; Department of Gynaecology, Academic Endometriosis Centre, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam University Medical Centers, Amsterdam, the Netherlands. Electronic address: a.schreurs@amsterdamumc.nl.; de Leeuw RA; Department of Gynaecology, Academic Endometriosis Centre, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam University Medical Centers, Amsterdam, the Netherlands. Electronic address: r.a.deleeuw@amsterdamumc.nl.; Erwteman M; Department of Anesthesiology, Amsterdam University Medical Centers, location Academisch Medisch Centrum, Amsterdam, the Netherlands. Electronic address: m.erwteman@amsterdamumc.nl.; Dekker JJML; Department of Gynaecology, Academic Endometriosis Centre, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam University Medical Centers, Amsterdam, the Netherlands. Electronic address: jjml.dekker@amsterdamumc.nl.; Melgers I; Department of Gynaecology, Academic Endometriosis Centre, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam University Medical Centers, Amsterdam, the Netherlands. Electronic address: i.melgers@amsterdamumc.nl.; van der Horst HJR; Department of Pediatric Urology, Amsterdam University Medical Centers, location Emma children hospital, Amsterdam, the Netherlands. Electronic address: h.vanderhorst@amsterdamumc.nl.; Nieuwenhuijzen JA; Department of Urology, Amsterdam University Medical Centers, location Vrije Universiteit, Amsterdam, the Netherlands; Cancer Center Amsterdam, Imaging and Biomarkers & Cancer Treatment and Quality of Life, Amsterdam, the Netherlands. Electronic address: j.nieuwenhuijzen@amsterdamumc.nl.; Tytgat K; Department of Gastro-Enterology, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, the Netherlands. Electronic address: k.m.tytgat@amsterdamumc.nl.; Heineman DJ; Department of Cardiothoracic Surgery, Amsterdam University Medical Centers, location Vrije Universiteit, Amsterdam, the Netherlands. Electronic address: d.heineman@amsterdamumc.nl.; Dreyer K; Department of Gynaecology, Academic Endometriosis Centre, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam University Medical Centers, Amsterdam, the Netherlands. Electronic address: k.dreyer@amsterdamumc.nl.; Kallewaard JW; Department of Anesthesiology, Amsterdam University Medical Centers, location Academisch Medisch Centrum, Amsterdam, the Netherlands; Department of Anesthesiology, Rijnstate Ziekenhuis, Arnhem, the Netherlands. Electronic address: j.w.kallewaard@amsterdamumc.nl.; Mijatovic V; Department of Gynaecology, Academic Endometriosis Centre, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam University Medical Centers, Amsterdam, the Netherlands. Electronic address: mijatovic@amsterdamumc.nl. |
| Source: | European journal of obstetrics, gynecology, and reproductive biology [Eur J Obstet Gynecol Reprod Biol] 2026 May; Vol. 321, pp. 115040. Date of Electronic Publication: 2026 Feb 26. |
| Publication Type: | Journal Article; Practice Guideline |
| Language: | English |
| Journal Info: | Publisher: Elsevier Scientific Publishers Country of Publication: Ireland NLM ID: 0375672 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1872-7654 (Electronic) Linking ISSN: 03012115 NLM ISO Abbreviation: Eur J Obstet Gynecol Reprod Biol Subsets: MEDLINE |
| Imprint Name(s): | Publication: Limerick : Elsevier Scientific Publishers; Original Publication: Amsterdam, Excerpta Medica. |
| MeSH Terms: | Endometriosis*/complications ; Pain Management*/standards ; Pain Management*/methods ; Pelvic Pain*/etiology ; Pelvic Pain*/drug therapy; Humans ; Female ; Netherlands ; Consensus |
| Abstract: | Objective: to develop a step-by-step guideline to the medical management of pain in women with endometriosis from a national modified eDELPHI process in the Netherlands.; Methods: An eDELPHI procedure was preceded by an multidisciplinary expert meeting with experts in Obstetrics and Gynaecology (OBGYN), Colorectal Surgery, Anesthesiology, Urology, and Gastro-Enterology to develop a flow diagram for endometriosis pain management. The flow diagram was tested in two rounds of an eDELPHI procedure among experts in the field of OBGYN and Anesthesiology. They were recruited through a digital newsletter. For each item, it was predefined that consensus would be reached when at least 70% of respondents agreed.; Results: consensus was reached on all but one item. The first two steps adhere to the WHO step-by-step approach. The third step in endometriosis management is the addition of TCAs in case of neuropathic pain. It is recommended only to use metamizol and opioids for the short term. Muscarinic receptor antagonists are accepted treatment for bladder endometriosis. The use of COX-2 inhibitors is suggested but is not an established step in pain management. It is advised to prescribe magnesium hydroxide with all types of pain management because of its positive effect on gastro-intestinal symptoms. Finally, proton pump inhibitors (PPIs) can be prescribed with use of NSAIDs.; Conclusions: consensus on a step-by-step guideline on pain management between Dutch endometriosis care experts was achieved. However, the use of some medication types are based on limited scientific evidence, underlining the importance to further investigate pain management options for endometriosis.; (Copyright © 2026 The Authors. Published by Elsevier B.V. All rights reserved.) |
| Competing Interests: | Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. |
| Contributed Indexing: | Keywords: Chronic pain; Endometriosis; Medical pain management; eDELPHI procedure |
| Entry Date(s): | Date Created: 20260305 Date Completed: 20260423 Latest Revision: 20260423 |
| Update Code: | 20260424 |
| DOI: | 10.1016/j.ejogrb.2026.115040 |
| PMID: | 41785714 |
| Database: | MEDLINE |
Journal Article; Practice Guideline