Pain in the upper anterior lateral part of the thigh in women affected by endometriosis study of sensitive neuropathy

In women with endometriosis and pain in the anterior-lateral part of the thigh, neurologic examination and skin biopsy could be an important way to diagnose nerve invasion, guiding suitable treatments.

Arianna Pacchiarotti, M.D., Ph.D., Giusi Natalia Milazzo, M.D., Antonella Biasiotta, M.D., Andrea Truini, M.D., Ph.D., Giovanni Antonini, M.D., Ph.D., Paola Frati, Ph.D., Vincenzo Gentile, M.D., Ph.D., Donatella Caserta, M.D., Ph.D., Massimo Moscarini, M.D., Ph.D.

Volume 100, Issue 1, Pages 122-126, July 2013


To assess whether pain in the anterior-lateral part of the thigh in women affected by endometriosis is due to femoral nerve invasion by endometriotic implants.

Case-control study.


We enrolled 30 patients with endometriosis and leg pain in the anterior-lateral part of the thigh and 30 healthy women.

Skin biopsy and neurologic examination for detection of neuropathy.

Main Outcome Measure(s):
Intraepidermal small fiber density reduction and positive neurologic examination agree with sensitive neuropathy.

Biopsy results showed no statistically significant difference between the case group and the control group. At neurologic examination nine patients in the study group (30%) showed positive results, none in the control group showed signs. These nine patients had reduced intraepidermal small fiber density, compared to the lower cutoff values of the control group, suggesting a sensitive neuropathy.

When there is leg pain in women with endometriosis it is important to distinguish neuropathic from referred pain. Skin biopsy and neurologic examination should be introduced in the management of leg pain in endometriosis, due to their low invasiveness to diagnose a sensitive neuropathy. As a result early detection of nerve injury and planning for a prompt specific treatment would be possible.

  • Amanda N. Kallen

    Thank you for this very interesting study! I did have a question for the author. It was mentioned that all patients had ovarian cysts on the ipsilateral side to the leg pain. Was any assessment of pain improvement after surgery done – i.e. did leg pain improve after removal of endometriosis in patients who had abnormal neurologic exam and decreased INEF density?

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