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Impact of diet on pain perception in women with endometriosis: A systematic review

  • Una Áslaug Sverrisdóttir
    Affiliations
    Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark

    Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark
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  • Sara Hansen
    Affiliations
    Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark

    Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark
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  • Martin Rudnicki
    Correspondence
    Corresponding author at: Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark.
    Affiliations
    Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark

    Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark
    Search for articles by this author
Published:February 25, 2022DOI:https://doi.org/10.1016/j.ejogrb.2022.02.028

      Abstract

      Introduction

      Endometriosis is a painful, chronic inflammatory disorder that is difficult to treat. Studies have suggested that diet may have a therapeutic effect on chronic inflammation. However, only limited information is available regarding the impact of diet on pain perception in relation to endometriosis. As such, the aim of this review was to evaluate if diet has any impact on pain perception in women suffering from endometriosis.

      Materials and methods

      A systematic review was conducted by searching Medline and Embase to identify randomized controlled trials and observational studies adhering to the PRISMA and SWiM guidelines. A table summarizing the findings was developed using the GRADE approach. Inclusion criteria were: women of reproductive age; laparoscopically confirmed diagnosis of endometriosis; and intervention including any type of dietary change. This review was registered with PROSPERO on 14 November 2020 (CRD42020212314).

      Results

      In total, the database search identified 2185 studies; of these, six studies fulfilled the inclusion criteria. The Newcastle–Ottawa scale and the Cochrane tool were used to assess the studies, which were concluded to be of high quality and to have low risk of bias. All studies had a positive impact on pain perception, with all except one study reporting a significant reduction in pain perception, indicating that high intake of polyunsaturated fatty acids, a gluten-free diet and a low nickel diet may improve painful endometriosis. It was not possible to conduct a meta-analysis due to considerable heterogeneity amongst the included studies due to differences in dietary adherence, dietary therapies, outcome measurements, populations, durations and study designs.

      Conclusion

      All studies found that diet had a positive impact on pain perception among women with endometriosis. However, the majority of available evidence on dietary interventions in relation to endometriosis-associated pain was derived from non-randomized controlled trials, which have multiple sources of bias. Therefore, further studies are needed to investigate diet and its effect on pain perception in women with endometriosis.

      Keywords

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      References

        • Ballweg M.L.
        Impact of endometriosis on women's health: comparative historical data show that the earlier the onset, the more severe the disease.
        Best Pract Res Clin Obstet Gynaecol. 2004; 18: 201-218
        • Rafique S.
        • Decherney A.H.
        Medical management of endometriosis.
        Clin Obstet Gynecol. 2017; 60: 485-496
        • Parasar P.
        • Ozcan P.
        • Terry K.L.
        Endometriosis: epidemiology, diagnosis and clinical management.
        Curr Obstet Gynecol Rep. 2017; 6: 34-41
        • Mehedintu C.
        • Plotogea M.N.
        • Ionescu S.
        • Antonovici M.
        Endometriosis still a challenge.
        J Med Life. 2014; 7: 349-357
        • Aredo J.
        • Heyrana K.
        • Karp B.
        • Shah J.
        • Stratton P.
        Relating chronic pelvic pain and endometriosis to signs of sensitization and myofascial pain and dysfunction.
        Semin Reprod Med. 2017; 35: 088-097
        • Costantini R.
        • Affaitati G.
        • Wesselmann U.
        • Czakanski P.
        • Giamberardino M.A.
        Visceral pain as a triggering factor for fibromyalgia symptoms in comorbid patients.
        Pain. 2017; 158: 1925-1937
        • Signorile P.G.
        • Viceconte R.
        • Baldi A.
        Novel dietary supplement association reduces symptoms in endometriosis patients.
        J Cell Physiol. 2018; 233: 5920-5925
        • Galland L.
        Diet and inflammation.
        Nutr Clin Pract. 2010; 25: 634-640
        • Bost J.W.
        • Maroon A.
        • Maroon J.C
        Natural anti-inflammatory agents for pain relief.
        Surg Neurol Int. 2010; 1: 80https://doi.org/10.4103/2152-7806.73804
        • Cabré E.
        • Mañosa M.
        • Gassull M.A.
        Omega-3 fatty acids and inflammatory bowel diseases – a systematic review.
        Br J Nutr. 2012; 107: S240-S252
        • Navarini L.
        • Afeltra A.
        • Gallo Afflitto G.
        • Margiotta D.P.E.
        Polyunsaturated fatty acids: any role in rheumatoid arthritis?.
        Lipids Health Dis. 2017; 16: 197
        • Marziali M.
        • Venza M.
        • Lazzaro S.
        • Lazzaro A.
        • Micossi C.
        • Stolfi V.M.
        Gluten-free diet: a new strategy for management of painful endometriosis related symptoms?.
        Minerva Chir. 2012; 67: 499-504
        • Biesiekierski J.R.
        What is gluten?.
        J Gastroenterol Hepatol. 2017; 32: 78-81
        • Borghini R.
        • Porpora M.G.
        • Casale R.
        • Marino M.
        • Palmieri E.
        • Greco N.
        • et al.
        Irritable bowel syndrome-like disorders in endometriosis: prevalence of nickel sensitivity and effects of a low-nickel diet.
        An open-label pilot study. Nutrients. 2020; 12: 341https://doi.org/10.3390/nu12020341
        • Sharma A.D
        Low nickel diet in dermatology.
        Indian J Dermatol. 2013; 58: 240https://doi.org/10.4103/0019-5154.110846
      1. Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ 2015;350:g7647.

      2. Campbell M, McKenzie JE, Sowden A, et al. Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. BMJ 2020;368:l6890.

      3. Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928.

      4. Wells GA, Shea B, O'Connell D, et al. The Newcastle–Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.

        • Sesti F.
        • Pietropolli A.
        • Capozzolo T.
        • Broccoli P.
        • Pierangeli S.
        • Bollea M.R.
        • et al.
        Hormonal suppression treatment or dietary therapy versus placebo in the control of painful symptoms after conservative surgery for endometriosis stage III–IV. A randomized comparative trial.
        Fertil Steril. 2007; 88: 1541-1547
        • Moore J.S.
        • Gibson P.R.
        • Perry R.E.
        • Burgell R.E.
        Endometriosis in patients with irritable bowel syndrome: specific symptomatic and demographic profile, and response to the low FODMAP diet.
        Aust N Z J Obstet Gynaecol. 2017; 57: 201-205
        • Armour M.
        • Sinclair J.
        • Chalmers K.J.
        • Smith C.A.
        Self-management strategies amongst Australian women with endometriosis: a national online survey.
        BMC Complement Altern Med. 2019; 19: 17
        • Younger J.
        • McCue R.
        • Mackey S.
        Pain outcomes: a brief review of instruments and techniques.
        Curr Pain Headache Rep. 2009; 13: 39-43
        • Delgado D.A.
        • Lambert B.S.
        • Boutris N.
        • McCulloch P.C.
        • Robbins A.B.
        • Moreno M.R.
        • et al.
        Validation of digital visual analog scale pain scoring with a traditional paper-based visual analog scale in adults.
        J Am Acad Orthop Surg Glob Res Rev. 2018; 2: e088https://doi.org/10.5435/JAAOSGlobal-D-17-00088
        • Calder P.C.
        Immunoregulatory and anti-inflammatory effects of n-3 polyunsaturated fatty acids.
        Braz J Med Biol Res. 1998; 31: 467-490
        • Ricciotti E.
        • FitzGerald G.A.
        Prostaglandins and inflammation.
        Arterioscler Thromb Vasc Biol. 2011; 31: 986-1000
        • Gazvani M.R.
        • Smith L.
        • Haggarty P.
        • Fowler P.A.
        • Templeton A.
        High omega-3:omega-6 fatty acid ratios in culture medium reduce endometrial-cell survival in combined endometrial gland and stromal cell cultures from women with and without endometriosis.
        Fertil Steril. 2001; 76: 717-722
        • Rolla E.
        Endometriosis: advances and controversies in classification, pathogenesis, diagnosis, and treatment.
        F1000Res. 2019; 8: 529https://doi.org/10.12688/f1000research10.12688/f1000research.14817.1