Standardizing medical pain management for the endometriosis patient: A Dutch modified eDelphi procedure

A P van Haaps; A M F Schreurs; R A de Leeuw; M Erwteman; J J M L Dekker; I Melgers; H J R van der Horst; J A Nieuwenhuijzen; K Tytgat; D J Heineman; K Dreyer; J W Kallewaard; V Mijatovic

doi:10.1016/j.ejogrb.2026.115040

Standardizing medical pain management for the endometriosis patient: A Dutch modified eDelphi procedure

Department of Gynaecology
Academic Endometriosis Centre
Amsterdam University Medical Centers
Department of Anesthesiology
Department of Pediatric Urology, Netherlands
Department of Urology
Department of Gastro-enterology and Hepatology, Genk, Belgium
Department of Cardiothoracic Surgery

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Abstract

OBJECTIVE: to develop a step-by-step guideline to the medical management of pain in women with endometriosis from a national modified eDELPHI process in the Netherlands.

METHODS: An eDELPHI procedure was preceded by an multidisciplinary expert meeting with experts in Obstetrics and Gynaecology (OBGYN), Colorectal Surgery, Anesthesiology, Urology, and Gastro-Enterology to develop a flow diagram for endometriosis pain management. The flow diagram was tested in two rounds of an eDELPHI procedure among experts in the field of OBGYN and Anesthesiology. They were recruited through a digital newsletter. For each item, it was predefined that consensus would be reached when at least 70% of respondents agreed.

RESULTS: consensus was reached on all but one item. The first two steps adhere to the WHO step-by-step approach. The third step in endometriosis management is the addition of TCAs in case of neuropathic pain. It is recommended only to use metamizol and opioids for the short term. Muscarinic receptor antagonists are accepted treatment for bladder endometriosis. The use of COX-2 inhibitors is suggested but is not an established step in pain management. It is advised to prescribe magnesium hydroxide with all types of pain management because of its positive effect on gastro-intestinal symptoms. Finally, proton pump inhibitors (PPIs) can be prescribed with use of NSAIDs.

CONCLUSIONS: consensus on a step-by-step guideline on pain management between Dutch endometriosis care experts was achieved. However, the use of some medication types are based on limited scientific evidence, underlining the importance to further investigate pain management options for endometriosis.

Original language	English
Article number	115040
Pages (from-to)	115040
Journal	European journal of obstetrics, gynecology, and reproductive biology
Volume	321
Early online date	26 Feb 2026
DOIs	https://doi.org/10.1016/j.ejogrb.2026.115040
Publication status	Published - May 2026
Externally published	Yes

Keywords

Chronic pain
Endometriosis
Medical pain management
eDELPHI procedure

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van Haaps, A. P., Schreurs, A. M. F., de Leeuw, R. A., Erwteman, M., Dekker, J. J. M. L., Melgers, I., van der Horst, H. J. R., Nieuwenhuijzen, J. A., Tytgat, K., Heineman, D. J., Dreyer, K., Kallewaard, J. W., & Mijatovic, V. (2026). Standardizing medical pain management for the endometriosis patient: A Dutch modified eDelphi procedure. European journal of obstetrics, gynecology, and reproductive biology, 321, 115040. Article 115040. https://doi.org/10.1016/j.ejogrb.2026.115040

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abstract = "OBJECTIVE: to develop a step-by-step guideline to the medical management of pain in women with endometriosis from a national modified eDELPHI process in the Netherlands.METHODS: An eDELPHI procedure was preceded by an multidisciplinary expert meeting with experts in Obstetrics and Gynaecology (OBGYN), Colorectal Surgery, Anesthesiology, Urology, and Gastro-Enterology to develop a flow diagram for endometriosis pain management. The flow diagram was tested in two rounds of an eDELPHI procedure among experts in the field of OBGYN and Anesthesiology. They were recruited through a digital newsletter. For each item, it was predefined that consensus would be reached when at least 70\% of respondents agreed.RESULTS: consensus was reached on all but one item. The first two steps adhere to the WHO step-by-step approach. The third step in endometriosis management is the addition of TCAs in case of neuropathic pain. It is recommended only to use metamizol and opioids for the short term. Muscarinic receptor antagonists are accepted treatment for bladder endometriosis. The use of COX-2 inhibitors is suggested but is not an established step in pain management. It is advised to prescribe magnesium hydroxide with all types of pain management because of its positive effect on gastro-intestinal symptoms. Finally, proton pump inhibitors (PPIs) can be prescribed with use of NSAIDs.CONCLUSIONS: consensus on a step-by-step guideline on pain management between Dutch endometriosis care experts was achieved. However, the use of some medication types are based on limited scientific evidence, underlining the importance to further investigate pain management options for endometriosis.",

keywords = "Chronic pain, Endometriosis, Medical pain management, eDELPHI procedure",

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note = "Publisher Copyright: {\textcopyright} 2026 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/",

year = "2026",

month = may,

doi = "10.1016/j.ejogrb.2026.115040",

language = "English",

volume = "321",

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van Haaps, AP, Schreurs, AMF , de Leeuw, RA , Erwteman, M , Dekker, JJML , Melgers, I , van der Horst, HJR , Nieuwenhuijzen, JA, Tytgat, K, Heineman, DJ , Dreyer, K , Kallewaard, JW & Mijatovic, V 2026, 'Standardizing medical pain management for the endometriosis patient: A Dutch modified eDelphi procedure', European journal of obstetrics, gynecology, and reproductive biology, vol. 321, 115040, pp. 115040. https://doi.org/10.1016/j.ejogrb.2026.115040

TY - JOUR

T1 - Standardizing medical pain management for the endometriosis patient

T2 - A Dutch modified eDelphi procedure

AU - van Haaps, A P

AU - Schreurs, A M F

AU - de Leeuw, R A

AU - Erwteman, M

AU - Dekker, J J M L

AU - Melgers, I

AU - van der Horst, H J R

AU - Nieuwenhuijzen, J A

AU - Tytgat, K

AU - Heineman, D J

AU - Dreyer, K

AU - Kallewaard, J W

AU - Mijatovic, V

PY - 2026/5

Y1 - 2026/5

N2 - OBJECTIVE: to develop a step-by-step guideline to the medical management of pain in women with endometriosis from a national modified eDELPHI process in the Netherlands.METHODS: An eDELPHI procedure was preceded by an multidisciplinary expert meeting with experts in Obstetrics and Gynaecology (OBGYN), Colorectal Surgery, Anesthesiology, Urology, and Gastro-Enterology to develop a flow diagram for endometriosis pain management. The flow diagram was tested in two rounds of an eDELPHI procedure among experts in the field of OBGYN and Anesthesiology. They were recruited through a digital newsletter. For each item, it was predefined that consensus would be reached when at least 70% of respondents agreed.RESULTS: consensus was reached on all but one item. The first two steps adhere to the WHO step-by-step approach. The third step in endometriosis management is the addition of TCAs in case of neuropathic pain. It is recommended only to use metamizol and opioids for the short term. Muscarinic receptor antagonists are accepted treatment for bladder endometriosis. The use of COX-2 inhibitors is suggested but is not an established step in pain management. It is advised to prescribe magnesium hydroxide with all types of pain management because of its positive effect on gastro-intestinal symptoms. Finally, proton pump inhibitors (PPIs) can be prescribed with use of NSAIDs.CONCLUSIONS: consensus on a step-by-step guideline on pain management between Dutch endometriosis care experts was achieved. However, the use of some medication types are based on limited scientific evidence, underlining the importance to further investigate pain management options for endometriosis.

AB - OBJECTIVE: to develop a step-by-step guideline to the medical management of pain in women with endometriosis from a national modified eDELPHI process in the Netherlands.METHODS: An eDELPHI procedure was preceded by an multidisciplinary expert meeting with experts in Obstetrics and Gynaecology (OBGYN), Colorectal Surgery, Anesthesiology, Urology, and Gastro-Enterology to develop a flow diagram for endometriosis pain management. The flow diagram was tested in two rounds of an eDELPHI procedure among experts in the field of OBGYN and Anesthesiology. They were recruited through a digital newsletter. For each item, it was predefined that consensus would be reached when at least 70% of respondents agreed.RESULTS: consensus was reached on all but one item. The first two steps adhere to the WHO step-by-step approach. The third step in endometriosis management is the addition of TCAs in case of neuropathic pain. It is recommended only to use metamizol and opioids for the short term. Muscarinic receptor antagonists are accepted treatment for bladder endometriosis. The use of COX-2 inhibitors is suggested but is not an established step in pain management. It is advised to prescribe magnesium hydroxide with all types of pain management because of its positive effect on gastro-intestinal symptoms. Finally, proton pump inhibitors (PPIs) can be prescribed with use of NSAIDs.CONCLUSIONS: consensus on a step-by-step guideline on pain management between Dutch endometriosis care experts was achieved. However, the use of some medication types are based on limited scientific evidence, underlining the importance to further investigate pain management options for endometriosis.

KW - Chronic pain

KW - Endometriosis

KW - Medical pain management

KW - eDELPHI procedure

UR - https://www.scopus.com/pages/publications/105033137531

U2 - 10.1016/j.ejogrb.2026.115040

DO - 10.1016/j.ejogrb.2026.115040

M3 - Article

C2 - 41785714

SN - 0301-2115

VL - 321

SP - 115040

JO - European journal of obstetrics, gynecology, and reproductive biology

JF - European journal of obstetrics, gynecology, and reproductive biology

M1 - 115040

ER -

Standardizing medical pain management for the endometriosis patient: A Dutch modified eDelphi procedure

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Keywords

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