title: Psychotherapy With Somatosensory Stimulation for Endometriosis-Associated Pain: The Role of the Anterior Hippocampus.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  We have identified a putative neurobiological mechanism underlying the potent combination of psychotherapy and somatic stimulation in treating symptoms of endometriosis.
authors.affiliation: Somatosensory and Autonomic Therapy Research, Institute for Neuroradiology, Hannover Medical School, Hannover. Electronic address: beissner.florian@mh-hannover.de.
authors.forename: Florian
authors.initials: F
authors.lastname: Beissner
authors.affiliation: Clinic for Neurology, Technische Universität München, Munich; Department of Neuroradiology, Technische Universität München, Munich.
authors.forename: Christine
authors.initials: C
authors.lastname: Preibisch
authors.affiliation: Practice for Psychotherapeutic Medicine, Diessen.
authors.forename: Annemarie
authors.initials: A
authors.lastname: Schweizer-Arau
authors.affiliation: Department of Gynecologic Endocrinology and Fertility Disorders, Heidelberg University Women's Hospital, Heidelberg.
authors.forename: Roxana M
authors.initials: RM
authors.lastname: Popovici
authors.affiliation: Institute of Medical Psychology, Ludwig-Maximilians-Universität München, Munich; Division Integrative Health Promotion, University of Applied Sciences, Coburg, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Meissner
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D004715:Endometriosis / Q000503:physiopathology*; D005260:Female; D006624:Hippocampus / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D017699:Pelvic Pain / Q000628:therapy*; D010812:Physical Stimulation; D011613:Psychotherapy; D012044:Regression Analysis
keywords: Acupuncture; Anxiety; Endometriosis; Functional connectivity; Hippocampus; Masked independent component analysis; Pelvic pain