[Pain medicine aspects of the updated S2k guideline "Diagnosis and treatment of endometriosis"].

BACKGROUND

The scheduled update of the S2k guideline "Diagnosis and treatment of endometriosis", published by the Association of the Scientific Medical Societies in Germany (AWMF; registry number 015/045), was released on April 1, 2025.

METHODS

The guideline was developed under the coordination of the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (ÖGGG), and the Swiss Society for Gynecology and Obstetrics (SGGG), together with 34 scientific societies (including the German Pain Society), professional organizations and associations, and three patient self-help groups. The systematic literature search followed a predefined algorithm and covered the period from 2019 to 2023. In a structured consensus process, 73 recommendations and 25 statements were formulated in accordance with AWMF regulations.

RESULTS

Compared to the 2020 guideline, the following changes were made regarding pain management: core therapeutic principles were expanded to include chapters on pharmacological symptomatic pain treatment, psychosomatic therapy, complementary therapy, and additional as well as multimodal treatment approaches. A tiered, multimodal treatment strategy for chronic endometriosis-related pain was recommended.

CONCLUSION

The updated S2k guideline incorporates key concepts of pain medicine, including pain mechanisms (nociceptive, neuropathic, and nociplastic), risk factors for chronification, and biopsychosocial models. Recommendations for pharmacological and non-pharmacological interventions, including tiered multimodal treatment approaches, were developed and agreed upon in an interdisciplinary process based on current evidence and feasibility.