Florian Beissner1, Christine Preibisch2, Annemarie Schweizer-Arau3, Roxana M Popovici4, Karin Meissner5. 1. Somatosensory and Autonomic Therapy Research, Institute for Neuroradiology, Hannover Medical School, Hannover. Electronic address: beissner.florian@mh-hannover.de. 2. Clinic for Neurology, Technische Universität München, Munich; Department of Neuroradiology, Technische Universität München, Munich. 3. Practice for Psychotherapeutic Medicine, Diessen. 4. Department of Gynecologic Endocrinology and Fertility Disorders, Heidelberg University Women's Hospital, Heidelberg. 5. Institute of Medical Psychology, Ludwig-Maximilians-Universität München, Munich; Division Integrative Health Promotion, University of Applied Sciences, Coburg, Germany.
Abstract
BACKGROUND:Endometriosis is a gynecological disorder affecting 6%-10% of all women in their reproductive age. There is an emerging view in the literature that psychological trauma plays a central role in the pathogenesis of pelvic pain, one of the core symptoms of endometriosis. Here we report central nervous system mechanisms of a novel combination of psychotherapy and somatosensory stimulation that has recently shown remarkable effects in reducing pain, anxiety, and depressive symptoms in these patients. METHODS: We conducted a randomized controlled trial; 67 patients with severe endometriosis-associated pain (maximum pain: 7.6 ± 2.0, average pain: 4.5 ± 2.0 on a 10-point numeric rating scale) were included in the study and randomly allocated to intervention (35 patients) or waitlist control (32 patients) groups. Resting-state functional magnetic resonance imaging was used to assess brain connectivity of these patients at baseline, after 3 months of therapy, and after 6 months. The analysis focused on the hippocampus. RESULTS: We identified a cortical network comprising the right anterolateral hippocampus-a region modulating the hypothalamic-pituitary-adrenal axis-and somatosensory, viscerosensory, and interoceptive brain regions. Regression analysis showed that reduction in connectivity predicted therapy-induced improvement in patients׳ anxiety. CONCLUSIONS: We have identified a putative neurobiological mechanism underlying the potent combination of psychotherapy and somatic stimulation in treating symptoms of endometriosis.
RCT Entities:
BACKGROUND:Endometriosis is a gynecological disorder affecting 6%-10% of all women in their reproductive age. There is an emerging view in the literature that psychological trauma plays a central role in the pathogenesis of pelvic pain, one of the core symptoms of endometriosis. Here we report central nervous system mechanisms of a novel combination of psychotherapy and somatosensory stimulation that has recently shown remarkable effects in reducing pain, anxiety, and depressive symptoms in these patients. METHODS: We conducted a randomized controlled trial; 67 patients with severe endometriosis-associated pain (maximum pain: 7.6 ± 2.0, average pain: 4.5 ± 2.0 on a 10-point numeric rating scale) were included in the study and randomly allocated to intervention (35 patients) or waitlist control (32 patients) groups. Resting-state functional magnetic resonance imaging was used to assess brain connectivity of these patients at baseline, after 3 months of therapy, and after 6 months. The analysis focused on the hippocampus. RESULTS: We identified a cortical network comprising the right anterolateral hippocampus-a region modulating the hypothalamic-pituitary-adrenal axis-and somatosensory, viscerosensory, and interoceptive brain regions. Regression analysis showed that reduction in connectivity predicted therapy-induced improvement in patients׳ anxiety. CONCLUSIONS: We have identified a putative neurobiological mechanism underlying the potent combination of psychotherapy and somatic stimulation in treating symptoms of endometriosis.
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