Defining the Role for Descending Pain Modulation and Reward-Aversion Processes Towards the Development of Chronic Pain in Endometriosis
Abstract
Overview: Endometriosis, a condition in which uterine tissue grows outside the uterus, is a debilitating disease, affecting millions of women and costs the United States approximately $78 billion annually in pain-related disability. It has a deleterious impact on physical and emotional functioning, as well as quality of life, and is the leading cause of chronic pelvic pain (CPP). Following laparoscopic surgery, to both confirm the diagnosis and remove the ectopic tissue, patients are commonly managed with a hormonal regimen during the childbearing years. Despite these treatments, approximately 30% of women report no improvement in their pelvic pain after surgery and the degree of short-term pain improvement among the remaining patients varies. Pain frequently recurs without evidence of recurrent disease; however, there are no effective treatments for this subset of treatment non-responders who continue to have CPP. Of grave concern is that in the current opioid epidemic, 24% of obstetrician/gynecologists reportedly prescribe opioids for endometriosis-related pain. One of the Fiscal Year 2018 Peer Reviewed Medical Research Program Topic Areas is Endometriosis while a second is Chronic Pain Management, and the current proposal fits well under both topics. Specifically, the current project brings together a team of experts in fields of pain, behavioral science, neuroscience, gynecology, and epidemiology to elucidate the factors contributing to CPP associated with endometriosis and to understand the mechanisms that sustain or resolve chronic pain in this vulnerable population. Of particular relevance is that women make up more than 15% of the US military as enlisted personnel and endometriosis may currently prevent individuals from joining and serving in the Military. A 2010 study conducted on women Veterans utilizing the Department of Veterans Affairs (VA) healthcare system found that the most frequent reproductive health diagnoses among those aged 18-44 were menstrual disorders and endometriosis (n=16,658). Compared with women without any reproductive health diagnoses, a higher proportion of female Veterans with such diagnoses had concomitant medical and mental health diagnoses and had more VA outpatient encounters. Our Question: How adolescents with a developing brain and nervous system compare to adult women with endometriosis is not known and is necessary in order to discover patient characteristic and disease subtype-specific algorithms that will establish personalized, precision medicine for endometriosis diagnosis and subsequent treatment selection. Failure to meet these needs has resulted in diagnostic delays and inadequate symptom remediation for hundreds of girls and women, causing significant personal and economic health costs. Our Approach: This is a neuroimaging study that examines changes in brain structure and function and correlates these findings with psychological functioning and pain sensitivity across three aims: (1) Age-Related Changes: We will examine differences across three age cohorts of women with surgically confirmed endometriosis (12-17; 18-25; 26-44) compared to healthy controls. (2) Surgical Treatment Responsivity: We will compare the same brain and psychological and pain sensitivity tests in adolescent and young adult women presenting for surgery for endometriosis, comparing those that have and those that do not have pain at 3 months post-surgery. (3) Comparison with Existing Data: We will compare data from Aim 1 to our existing databases of matched patients across the same age groups with migraines who have undergone the same type of testing. Migraine may parallel disease phenotypes to endometriosis in that it is a visceral pain that is intermittent in nature in its episodic form, involves inflammation, and it can chronify. Hypothesis: We hypothesize that (1) intermittent or ongoing pain in patients with endometriosis produces a sensitized peripheral and central ne
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Nov 19, 2019
- Source ID
- W81XWH1910560
Entities
People
- Christine B Sieberg
Organizations
- Boston Children's Hospital
- United States Army