{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:09:09Z","timestamp":1792782549656,"version":"4.5.0"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Ruppin Academic Center","id":[{"id":"https:\/\/ror.org\/0361c8163","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int Urogynecol J"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction and Hypothesis<\/jats:title>\n                    <jats:p>Chronic pelvic pain (CPP) often persists despite repeated organ-directed evaluation and treatment. We proposed that integrating disease-specific diagnosis with pain-mechanism phenotyping would provide a more clinically useful framework for explaining symptom persistence and selecting care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A structured narrative review was conducted using PubMed\/MEDLINE, PubMed Central, the Cochrane Library, professional guidelines, journal websites, and reference lists. English-language literature published from January 2020 to May 2026 was prioritized, with earlier seminal sources included for foundational concepts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Evidence indicates that CPP commonly reflects interacting nociceptive, neuropathic, nociplastic, musculoskeletal, psychological, sexual, and social contributors. Central sensitization and nociplastic pain may help explain disproportionate, widespread, or persistent pain, while pelvic floor dysfunction, distress, catastrophizing, fear-avoidance, sleep disturbance, and sexual pain can intensify disability. Current guidelines and reviews support comprehensive assessment, pelvic floor physical therapy when indicated, pain neuroscience education, psychological pain interventions, sexual counseling, disease-specific treatment, and coordinated multidisciplinary follow-up. Treatment matching should be based on dominant mechanisms and patient-prioritized outcomes rather than diagnosis or pain intensity alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A mechanism-based biopsychosocial approach validates CPP as real while broadening therapeutic targets. Combining rigorous disease evaluation with pain phenotyping may reduce fragmented care and improve function, intimacy, quality of life, and patient\u2013clinician communication.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00192-026-06899-8","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T12:21:35Z","timestamp":1790252495000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Reframing Chronic Pelvic Pain in Women: Central Sensitization, Psychosocial Burden, and Mechanism-Based Multidisciplinary Care"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3281-8670","authenticated-orcid":false,"given":"Yael","family":"Sela","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2928-8015","authenticated-orcid":false,"given":"Keren","family":"Grinberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4014-2874","authenticated-orcid":false,"given":"Rachel","family":"Nissanholtz-Gannot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"6899_CR1","doi-asserted-by":"publisher","first-page":"2381","DOI":"10.1001\/jama.2021.2631","volume":"325","author":"G Lamvu","year":"2021","unstructured":"Lamvu G, Carrillo J, Ouyang C, Rapkin A. Chronic pelvic pain in women: a review. JAMA. 2021;325:2381\u201391. https:\/\/doi.org\/10.1001\/jama.2021.2631","journal-title":"JAMA"},{"key":"6899_CR2","doi-asserted-by":"publisher","first-page":"e98","DOI":"10.1097\/AOG.0000000000003716","volume":"135","author":"American College of Obstetricians and Gynecologists","year":"2020","unstructured":"American College of Obstetricians and Gynecologists. Chronic pelvic pain: ACOG practice bulletin, number 218. Obstet Gynecol. 2020;135:e98\u2013109. https:\/\/doi.org\/10.1097\/AOG.0000000000003716","journal-title":"Obstet Gynecol"},{"key":"6899_CR3","doi-asserted-by":"publisher","first-page":"3005","DOI":"10.3390\/ijerph17043005","volume":"17","author":"K Grinberg","year":"2020","unstructured":"Grinberg K, Sela Y, Nissanholtz-Gannot R. New insights about chronic pelvic pain syndrome (CPPS). Int J Environ Res Public Health. 2020;17:3005. https:\/\/doi.org\/10.3390\/ijerph17043005","journal-title":"Int J Environ Res Public Health"},{"key":"6899_CR4","unstructured":"International Association for the Study of Pain. IASP terminology: nociplastic pain. n.d. https:\/\/www.iasp-pain.org\/resources\/terminology\/ Accessed 15 July 2026."},{"key":"6899_CR5","doi-asserted-by":"publisher","first-page":"1406","DOI":"10.1016\/j.jpain.2023.03.005","volume":"24","author":"SR Till","year":"2023","unstructured":"Till SR, Schrepf A, Clauw DJ, et al. Association between nociplastic pain and pain severity and impact in women with chronic pelvic pain. J Pain. 2023;24:1406\u201314. https:\/\/doi.org\/10.1016\/j.jpain.2023.03.005","journal-title":"J Pain"},{"key":"6899_CR6","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1016\/j.medj.2023.02.006","volume":"4","author":"BI Karp","year":"2023","unstructured":"Karp BI, Stratton P. Endometriosis-associated chronic pelvic pain. Med. 2023;4:143\u20136. https:\/\/doi.org\/10.1016\/j.medj.2023.02.006","journal-title":"Med"},{"key":"6899_CR7","doi-asserted-by":"publisher","first-page":"7521","DOI":"10.3390\/jcm13247521","volume":"13","author":"A Gentles","year":"2024","unstructured":"Gentles A, Goodwin E, Bedaiwy Y, et al. Nociplastic pain in endometriosis: a scoping review. J Clin Med. 2024;13:7521. https:\/\/doi.org\/10.3390\/jcm13247521","journal-title":"J Clin Med"},{"key":"6899_CR8","doi-asserted-by":"publisher","first-page":"871","DOI":"10.3390\/toxins14120871","volume":"14","author":"WR Yu","year":"2022","unstructured":"Yu WR, Jiang YH, Jhang JF, et al. Treatment outcomes of intravesical botulinum toxin A injections on patients with interstitial cystitis\/bladder pain syndrome. Toxins (Basel). 2022;14:871. https:\/\/doi.org\/10.3390\/toxins14120871","journal-title":"Toxins (Basel)"},{"key":"6899_CR9","doi-asserted-by":"publisher","first-page":"102283","DOI":"10.1016\/j.jogc.2023.102283","volume":"46","author":"C Allaire","year":"2024","unstructured":"Allaire C, Yong PJ, Bajzak K, et al. Guideline no. 445: management of chronic pelvic pain. J Obstet Gynaecol Can. 2024;46:102283. https:\/\/doi.org\/10.1016\/j.jogc.2023.102283","journal-title":"J Obstet Gynaecol Can"},{"key":"6899_CR10","unstructured":"European Association of Urology. EAU guidelines on chronic pelvic pain. 2026. https:\/\/uroweb.org\/guidelines\/chronic-pelvic-pain Accessed 15 July 2026."},{"key":"6899_CR11","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1111\/1471-0528.17987","volume":"132","author":"S Johnson","year":"2025","unstructured":"Johnson S, Bradshaw A, Bresnahan R, et al. Biopsychosocial approaches for the management of female chronic pelvic pain: a systematic review. BJOG. 2025;132:266\u201377. https:\/\/doi.org\/10.1111\/1471-0528.17987","journal-title":"BJOG"},{"key":"6899_CR12","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1016\/j.ajog.2024.08.006","volume":"232","author":"M Starzec-Proserpio","year":"2025","unstructured":"Starzec-Proserpio M, Frawley H, B\u00f8 K, Morin M. Effectiveness of nonpharmacological conservative therapies for chronic pelvic pain in women: a systematic review and meta-analysis. Am J Obstet Gynecol. 2025;232:42\u201371. https:\/\/doi.org\/10.1016\/j.ajog.2024.08.006","journal-title":"Am J Obstet Gynecol"},{"key":"6899_CR13","doi-asserted-by":"publisher","first-page":"1140857","DOI":"10.3389\/frph.2023.1140857","volume":"5","author":"L Demetriou","year":"2023","unstructured":"Demetriou L, Krassowski M, Abreu Mendes P, et al. Clinical profiling of specific diagnostic subgroups of women with chronic pelvic pain. Front Reprod Health. 2023;5:1140857. https:\/\/doi.org\/10.3389\/frph.2023.1140857","journal-title":"Front Reprod Health"},{"key":"6899_CR14","doi-asserted-by":"publisher","first-page":"291","DOI":"10.36076\/ppj.2013\/16\/291","volume":"16","author":"S Kaya","year":"2013","unstructured":"Kaya S, Hermans L, Willems T, Roussel N, Meeus M. Central sensitization in urogynecological chronic pelvic pain: a systematic literature review. Pain Physician. 2013;16:291\u2013308.","journal-title":"Pain Physician"},{"key":"6899_CR15","doi-asserted-by":"publisher","first-page":"3851","DOI":"10.3390\/jcm12113851","volume":"12","author":"C Rubal","year":"2023","unstructured":"Rubal C, Pereira A, Sastre LC, et al. Managing vulvodynia with central sensitization: challenges and strategies. J Clin Med. 2023;12:3851. https:\/\/doi.org\/10.3390\/jcm12113851","journal-title":"J Clin Med"},{"key":"6899_CR16","doi-asserted-by":"publisher","first-page":"912","DOI":"10.1093\/jsxmed\/qdae096","volume":"21","author":"FM Nimbi","year":"2024","unstructured":"Nimbi FM, Renzi A, Mesce M, et al. Central sensitization symptoms in vulvodynia: exploring the role of temperament, personality traits, childhood adverse events, defense mechanisms, and mental pain on quality of life. J Sex Med. 2024;21:912\u201321. https:\/\/doi.org\/10.1093\/jsxmed\/qdae096","journal-title":"J Sex Med"},{"key":"6899_CR17","doi-asserted-by":"publisher","first-page":"174550572311999","DOI":"10.1177\/17455057231199949","volume":"19","author":"EP Rabinowitz","year":"2023","unstructured":"Rabinowitz EP, Sayer MA, Delahanty DL. The role of catastrophizing in chronic cyclical pelvic pain: a systematic review and meta-analysis. Womens Health (Lond). 2023;19:17455057231199948. https:\/\/doi.org\/10.1177\/17455057231199949","journal-title":"Womens Health (Lond)"},{"key":"6899_CR18","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1016\/j.ejogrb.2024.12.042","volume":"305","author":"J Nogueira Neto","year":"2025","unstructured":"Nogueira Neto J, da Costa Brito AI, Nogueira MB, et al. Prevalence of depression and anxiety in women with chronic pelvic pain: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2025;305:312\u20137. https:\/\/doi.org\/10.1016\/j.ejogrb.2024.12.042","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"6899_CR19","doi-asserted-by":"publisher","first-page":"1611","DOI":"10.1002\/ejp.1994","volume":"26","author":"AH Rogers","year":"2022","unstructured":"Rogers AH, Farris SG. A meta-analysis of the associations of elements of the fear-avoidance model of chronic pain with negative affect, depression, anxiety, pain-related disability and pain intensity. Eur J Pain. 2022;26:1611\u201335. https:\/\/doi.org\/10.1002\/ejp.1994","journal-title":"Eur J Pain"},{"key":"6899_CR20","doi-asserted-by":"publisher","first-page":"1119938","DOI":"10.3389\/fpsyt.2023.1119938","volume":"14","author":"J Huang","year":"2023","unstructured":"Huang J, Zhong Y, Duan Y, Sun J. Case report: new insights into persistent chronic pelvic pain syndrome with comorbid somatic symptom disorder. Front Psychiatry. 2023;14:1119938. https:\/\/doi.org\/10.3389\/fpsyt.2023.1119938","journal-title":"Front Psychiatry"},{"key":"6899_CR21","doi-asserted-by":"publisher","first-page":"1015","DOI":"10.1080\/09513590.2020.1812570","volume":"36","author":"FR P\u00e9rez-L\u00f3pez","year":"2020","unstructured":"P\u00e9rez-L\u00f3pez FR, Ornat L, P\u00e9rez-Roncero GR, et al. The effect of endometriosis on sexual function as assessed with the Female Sexual Function Index: systematic review and meta-analysis. Gynecol Endocrinol. 2020;36:1015\u201323. https:\/\/doi.org\/10.1080\/09513590.2020.1812570","journal-title":"Gynecol Endocrinol"},{"key":"6899_CR22","doi-asserted-by":"publisher","first-page":"1184","DOI":"10.1089\/jwh.2020.8291","volume":"29","author":"S Caruso","year":"2020","unstructured":"Caruso S, Cianci A, Iraci M, et al. Does nomegestrol acetate plus 17beta-estradiol oral contraceptive improve endometriosis-associated chronic pelvic pain in women? J Womens Health (Larchmt). 2020;29:1184\u201391. https:\/\/doi.org\/10.1089\/jwh.2020.8291","journal-title":"J Womens Health (Larchmt)"},{"key":"6899_CR23","doi-asserted-by":"publisher","first-page":"1206","DOI":"10.1093\/jsxmed\/qdad089","volume":"20","author":"S Kadah","year":"2023","unstructured":"Kadah S, Soh SE, Morin M, et al. Are pelvic pain and increased pelvic floor muscle tone associated in women with persistent noncancer pelvic pain? A systematic review and meta-analysis. J Sex Med. 2023;20:1206\u201321. https:\/\/doi.org\/10.1093\/jsxmed\/qdad089","journal-title":"J Sex Med"},{"key":"6899_CR24","doi-asserted-by":"publisher","first-page":"e70060","DOI":"10.1002\/ejp.70060","volume":"29","author":"C Andrews","year":"2025","unstructured":"Andrews C, Bird ML, Jose KA, Van Niekerk L. A scoping review of interdisciplinary care programs for women with persistent pelvic pain. Eur J Pain. 2025;29:e70060. https:\/\/doi.org\/10.1002\/ejp.70060","journal-title":"Eur J Pain"},{"key":"6899_CR25","doi-asserted-by":"publisher","first-page":"1141","DOI":"10.1097\/AJP.0000000000000633","volume":"34","author":"K Grinberg","year":"2018","unstructured":"Grinberg K, Granot M, Lowenstein L, Abramov L, Weissman-Fogel I. Negative illness perceptions are associated with a pronociceptive modulation profile and augmented pelvic pain. Clin J Pain. 2018;34:1141\u20138. https:\/\/doi.org\/10.1097\/AJP.0000000000000633","journal-title":"Clin J Pain"}],"container-title":["International Urogynecology Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00192-026-06899-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00192-026-06899-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00192-026-06899-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T12:21:40Z","timestamp":1790252500000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00192-026-06899-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,24]]},"references-count":25,"alternative-id":["6899"],"URL":"https:\/\/doi.org\/10.1007\/s00192-026-06899-8","relation":{},"ISSN":["0937-3462","1433-3023"],"issn-type":[{"value":"0937-3462","type":"print"},{"value":"1433-3023","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,24]]},"assertion":[{"value":"20 July 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 September 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Ethical approval was not required because this article is a narrative review based exclusively on previously published literature and did not involve human participants, identifiable human data, human tissue, or new data collection.","order":1,"name":"Ethics","label":"Ethical Approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"None.","order":2,"name":"Ethics","label":"Conflicts of Interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}