{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:16:16Z","timestamp":1783487776074,"version":"3.55.0"},"reference-count":53,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100015550","name":"Ministry of Health","doi-asserted-by":"publisher","award":["SUBZ.C280.26.041"],"award-info":[{"award-number":["SUBZ.C280.26.041"]}],"id":[{"id":"10.13039\/501100015550","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The surgical management of chronic pelvic pain (CPP), particularly in endometriosis, often focuses on lesion excision or nerve decompression. However, persistent pain frequently occurs despite \u201canatomical perfection,\u201d suggesting central nervous system involvement. Neuropelveology faces a \u201csurgical paradox\u201d when dealing with central sensitization (CS), where peripheral interventions fail to address a systemic nociplastic state. Methods: This systematic review followed PRISMA guidelines and was registered in PROSPERO (CRD420261335008). A search across PubMed, Embase, and Cochrane (2010\u20132026) identified 71 relevant studies involving over 12,000 participants. Results: CS prevalence in the endometriosis population ranges from 11.3% to 58.2%, rising to 74.8% in specialized tertiary referral centers. The Central Sensitization Inventory (CSI) is a robust predictor of surgical failure; every one-point increase in preoperative CSI raises the risk of persistent pain (OR 1.02, p = 0.02). Objective markers, such as the collapse of Conditioned Pain Modulation (CPM), confirm that \u201chigh-sensitizers\u201d (CSI \u2265 40) suffer from a systemic \u201csoftware\u201d failure of pain inhibition. Conclusions: We propose a paradigm shift in neuropelveology. In patients with high CSI scores (\u226540), functional neuromodulation\u2014specifically the LION procedure\u2014should be prioritized over traditional nerve decompression to address the nociplastic nature of the pain.<\/jats:p>","DOI":"10.3390\/jcm15135187","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T14:51:25Z","timestamp":1783003885000},"page":"5187","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Integrating the Central Sensitization Inventory (CSI) into Neuropelveological Practice: A Systematic Review of Endometriosis and Overlapping Pelvic Pain Syndromes"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9751-1218","authenticated-orcid":false,"given":"Piotr","family":"Lepka","sequence":"first","affiliation":[{"name":"Department of Oncological Gynecology, Lower Silesian Oncology, Pulmonology and Hematology Center, 53-413 Wroclaw, Poland"},{"name":"Clinical Department of Gynaecological Oncology, Department of Oncology, Faculty of Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulina","family":"Lepka","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery, 4th Military Teaching Hospital and Polyclinic in Wroclaw, 50-981 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8935-0311","authenticated-orcid":false,"given":"Marcin","family":"J\u0119dryka","sequence":"additional","affiliation":[{"name":"Department of Oncological Gynecology, Lower Silesian Oncology, Pulmonology and Hematology Center, 53-413 Wroclaw, Poland"},{"name":"Clinical Department of Gynaecological Oncology, Department of Oncology, Faculty of Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2421","DOI":"10.2174\/1381612825666190722095401","article-title":"Is there a Relationship Between Vitamin D and Endometriosis? 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