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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Article Info
Publication History
Published online: January 16, 2017
Accepted:
January 9,
2017
Received in revised form:
December 9,
2016
Received:
August 2,
2016
Identification
Copyright
© Society of Biological Psychiatry, 2017.
