Cortical Plasticity in a Complex Intervention for Endometriosis

The aim of the study is to test, if patients suffering from Endometriosis show changes in their brain function, when being treated with SART (Systemic Autoregulation Therapy), a complex intervention consisting of interventions from Traditional Chinese Medicine (TCM) and Western Hypnotherapy. Functional and structural brain changes are assessed using Magnetic Resonance Imaging data which are analyzed by means of voxel-based morphometry (VBM), connectivity and perfusion analysis. A third outcome measure are changes of patients' heart rate variability, indicating the activity of their autonomic nervous system. With a number of questionnaires, changes in dysmenorrhea, chronic pelvic pain, menstruation regularity, dyspareunia, defecation pain, and quality of life are assessed during the SART treatment. During the treatment, we expect to see changes in cortical thickness, functional connectivity and perfusion of pain-related areas of the cortex, that correlate with the changes in heart rate variability.

Endometriosis, pain, sart, autonomic nervous system, fMRI, perfusion, connectivity, hypnotherapy, traditional Chinese medicine

This group will not be treated with SART but will regularly be examined by a gynecologist to detect sudden aggravation of the disease.

Complex intervention involving acupuncture and hypnotherapeutic techniques after an extensive diagnosis using chinese medical concepts. Patients will receive a maximum of 10 treatments, which are delivered weekly.

Changes in cortical thickness, functional connectivity and perfusion of brain areas related to the processing of pain and emotions.

Changes (ordinal) in pain scores as assessed by the questionnaire of the German Society For The Study Of Pain (DGSS).

Changes (ordinal) in the quality of life score as assessed by the questionnaire of the German Society For The Study Of Pain (DGSS).

Normalization of menstruation, pelvic pain, dyspareunia, defecation pain as assessed by the Erlangen Endometriosis questionnaire.

Inclusion Criteria: age > 18 years old clinically or histologically ensured diagnosis of Endometriosis preoperative and postoperative recurring ailments related to Endometriosis no hormone therapy (GnRH analogues, contraceptives) sufficient understanding of the German or English language persisting pain during menstruation (also in between) voluntary participation after information on the possible benefits and risks of the examination and intervention written informed consent Exclusion Criteria: alcohol addiction, drug addiction pregnancy diseases and other criteria, preventing an MRI examination: pacemaker neurostimulator or drug pump metal parts in the body (implants, splinters, etc.) claustrophobia

Meissner K, Schweizer-Arau A, Limmer A, Preibisch C, Popovici RM, Lange I, de Oriol B, Beissner F. Psychotherapy With Somatosensory Stimulation for Endometriosis-Associated Pain: A Randomized Controlled Trial. Obstet Gynecol. 2016 Nov;128(5):1134-1142. doi: 10.1097/AOG.0000000000001691.

Beissner F, Preibisch C, Schweizer-Arau A, Popovici RM, Meissner K. Psychotherapy With Somatosensory Stimulation for Endometriosis-Associated Pain: The Role of the Anterior Hippocampus. Biol Psychiatry. 2018 Nov 15;84(10):734-742. doi: 10.1016/j.biopsych.2017.01.006. Epub 2017 Jan 16.