E3 PreliminaryPreliminaryPEM not requiredMethods-PaperPeer-reviewedMachine draft
Clinical Criteria of Central Sensitization in Chronic Pelvic and Perineal Pain (Convergences PP Criteria): Elaboration of a Clinical Evaluation Tool Based on Formal Expert Consensus.
Levesque, Amélie, Riant, Thibault, Ploteau, Stéphane et al. · Pain medicine (Malden, Mass.) · 2018 · DOI
Quick Summary
This study created a simple checklist to help doctors identify when chronic pelvic pain is caused by the nervous system becoming overly sensitive, rather than from a structural injury or disease they can see on tests. Experts agreed on 10 key signs to look for, including pain that changes in intensity, pain triggered by normal activities, and having other conditions like fibromyalgia or chronic fatigue syndrome alongside pelvic pain.
Why It Matters
ME/CFS patients frequently experience comorbid pelvic and perineal pain, and this tool may help clinicians recognize central sensitization as a shared pathophysiological mechanism across these conditions. Understanding sensitization in pelvic pain could improve symptom management and validate the neurobiological basis of pain in ME/CFS and related disorders.
Observed Findings
- Ten clinical criteria achieved expert consensus for identifying central sensitization in CPP
- Comorbid conditions including chronic fatigue syndrome, fibromyalgia, migraine, and PTSD were recognized as associated features of pelvic pain with sensitization
- Expert agreement was reached on the importance of pain variability and allodynia as sensitization markers
- Trigger point tenderness in pelvic muscles (piriformis, obturator internus, levator ani) was included as a criterion
Inferred Conclusions
- A standardized clinical evaluation tool can help identify the sensitization component in CPP patients where pain appears disproportionate to objective findings
- Central sensitization represents an important pathophysiological mechanism in CPP management
- The presence of multiple comorbid conditions, including ME/CFS, should alert clinicians to possible central sensitization in pelvic pain
Remaining Questions
- Does using this clinical evaluation tool improve diagnostic accuracy and patient outcomes compared to standard evaluation?
- How sensitive and specific is this 10-item tool when tested prospectively in diverse patient populations?
- What is the relationship between sensitization in pelvic pain and sensitization in ME/CFS—do they share common mechanisms or occur independently?
What This Study Does Not Prove
This study does not prove that central sensitization causes pelvic pain, only that certain clinical signs may indicate its presence. The study does not validate the tool prospectively in actual patient populations, nor does it establish whether identifying sensitization changes patient outcomes. It does not determine causality between sensitization and any of the comorbid conditions listed.
Tags
Symptom:PainFatigueSensory Sensitivity
Method Flag:Weak Case DefinitionExploratory Only
Metadata
- DOI
- 10.1093/pm/pny030
- PMID
- 29522121
- Review status
- Machine draft
- Evidence level
- Early hypothesis, preprint, editorial, or weak support
- Last updated
- 8 April 2026
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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