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Psychotherapy With Somatosensory Stimulation for Endometriosis-Associated Pain: The Role of the Anterior Hippocampus

  • Author Footnotes
    1 FB and CP contributed equally to this work.
    Florian Beissner
    Correspondence
    Address correspondence to Florian Beissner, Dr. phil. nat., Somatosensory and Autonomic Therapy Research, Institute for Neuroradiology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany; .
    Footnotes
    1 FB and CP contributed equally to this work.
    Affiliations
    Somatosensory and Autonomic Therapy Research, Institute for Neuroradiology, Hannover Medical School, Hannover
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  • Author Footnotes
    1 FB and CP contributed equally to this work.
    Christine Preibisch
    Footnotes
    1 FB and CP contributed equally to this work.
    Affiliations
    Clinic for Neurology, Technische Universität München, Munich

    Department of Neuroradiology, Technische Universität München, Munich
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  • Annemarie Schweizer-Arau
    Affiliations
    Practice for Psychotherapeutic Medicine, Diessen
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  • Roxana M. Popovici
    Affiliations
    Department of Gynecologic Endocrinology and Fertility Disorders, Heidelberg University Women’s Hospital, Heidelberg
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  • Karin Meissner
    Affiliations
    Institute of Medical Psychology, Ludwig-Maximilians-Universität München, Munich

    Division Integrative Health Promotion, University of Applied Sciences, Coburg, Germany
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  • Author Footnotes
    1 FB and CP contributed equally to this work.

      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.

      Keywords

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