A Combination Treatment of Psychotherapy With Somatosensory Stimulation for Pain Reduction

This publication uses this idea that "Endometriosis-related pain may be psychological in nature" and suggests that a combination treatment of "Psychotherapy With Somatosensory Stimulation" will counteract the pain.

Key Points

Highlights:

• The authors of this randomized controlled clinical trial wanted to see the effects of a combination treatment of psychotherapy and somatic sensation on endometriosis-association pain, namely pelvic pain, anxiety, and depression. They found that this novel therapy influences a cortical network of the brain that is associated with the anterior hippocampus.

Importance:

• The mechanism that causes endometriosis-related pain remains elusive. Recent research has shed light on the fact that this symptom development may be physiological. Understanding the mechanism is important because it will allow researchers to develop more efficient and targeted therapies for those suffering from endometriosis.

What’s done here?

• There were 67 participants with endometriosis who were suffering from pelvic pain, split into two groups: an intervention group and a control group.
• There were three study visits at the start - 3 months and six months after the study began. At each appointment, the patient reported a questionnaire to determine the symptoms, associated pain levels, and overall quality of life. The patients were also required to undergo structural and functional MRI scans between the 2nd and 6th day of their menstrual cycle.
• The intervention was integrative psychotherapy alongside somatic sensation, which aimed to involve both the mind and the body in the process of attaining relief.
  • The psychotherapy brought together elements of hypnotherapy, mindfulness-based psychotherapy, cognitive behavioral and problem-solving therapies.
  • The intervention appointments typically lasted 60 minutes and participants were first asked to list their worries and the physical sensations that accompanied these concerns. Then the therapist uses hypnotic therapy to uncover memories.
  • The patient is also subject to acupuncture and related techniques, such as moxibustion and cupping.
• The data analysis was centered on the hippocampus; and include data preprocessing, identification of functionally independent Hippocampal sub-regions, assessment of whole-brain connectivity of Hippocampal sub-regions, and repeated measures analysis of variance.
• Another form of analysis used was regression analysis looking at connectivity and clinical outcomes.

Key results:

• After three months there was a significant improvement in the treatment group than the control group; however, once the control group started treatment at three months, at six months they improved nearly as much as the treatment group in a variety of areas including but not limited to pain, anxiety, and depression.
• There was a significant decrease in connectivity between the brain and three parts of the anterior hippocampus: the right anterolateral hippocampus and somatosensory or interoceptive brain areas.
• The above connectivity mechanism was found to underlie the combination treatment of psychotherapy and somatic sensation, which this study proved reduced endometriosis-associated pain.

Limitations of the study:

• Some aspects of this study required self-reporting on the part of the participants, and that could limit the accuracy of this study.
• While conducting the study, the researchers did not explore the effects of multifactorial causes of pelvic pain.
• Within the study, the researchers cite the primary limitation, like the fact that observed improvements seen over the course of the study cannot be attributed to the specific treatment. Additionally, since the study had no matched control group with related chronic pain symptoms, the inferences about endometriosis that could be reached are limited.
• A stepwise multivariable regression analysis, which is used in this study, is limited in the fact that is only exploratory.

Lay Summary

Women suffering from endometriosis often cite pelvic pain, anxiety, and depression as some of the worst core symptoms experienced due to the disease; however, emerging research has shown these signs, specifically pelvic pain, may be influenced by psychological trauma. In their publication titled “Psychotherapy With Somatosensory Stimulation for Endometriosis-Associated Pain: The Role of the Anterior Hippocampus,” Beissner et al. delve further into this area of research. They hypothesize that a combination treatment of psychotherapy with somatosensory stimulation would reduce the intensity of endometriosis-associated symptoms by altering the functional relationship between the anterior hippocampus, an area often changed in traumatized individuals and the rest of the brain. The study and its findings have been published in Biological Psychiatry.

This randomized controlled clinical trial study had 67 participants, all of whom had severe endometriosis-associated pain. These participants were then split into two groups: a control group and an intervention group. The intervention was a combination of psychotherapy and somatosensory stimulation. Primarily, the 60-minute sessions sought to bring together the mind and body in a therapeutic relief inducing process. The participants were required to visit the clinic three times: at the beginning of the study, three months after the start of the study, and six months after the start of the study. At each appointment, the patients are given a questionnaire to assess symptoms and symptom intensity. The participants also underwent a Magnetic Resonance Imaging (MRI) exam, which consisted of functional and structural scans. Overall, the researchers used the MRI and other data to determine the impact on the hippocampus.

The researchers ultimately found that there was a cortical network of interest consisting of the right anterolateral hippocampus and somatosensory or interoceptive brain areas, that can reduce endometriosis-associated pain when altered by a combination treatment of psychotherapy and somatic stimulation.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/28258747