Psychological characteristics, pain perception and voxel-based brain morphology of women with chronic pelvic pain in the presence and absence of endometriosis

L. Maulitz, Susanne Stickel, Elmar Stickeler, Atanas Ignatov, Natalia Chechko, S.N. Tchaikovski
In: Geburtshilfe und Frauenheilkunde · 2022 · vol. 82(10) , pp. e123–e124 · doi:10.1055/s-0042-1756947 · W4307890722
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This study investigates whether chronic pelvic pain, comorbid mental disorders, or endometriosis itself drives differences in psychological characteristics, pain perception, and voxel-based brain morphology in women.

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This prospective study compared psychological characteristics, thermal pain perception, and brain gray matter volume in women with chronic pelvic pain, both with and without endometriosis, against healthy controls. The results indicated that while groups were similar in demographics and pain thresholds, patients with endometriosis exhibited significantly higher gray matter volume in specific regions like the frontal medial cortex and cingulate gyrus compared to those with pain alone or healthy individuals. Conversely, participants with chronic pelvic pain but no endometriosis showed decreased gray matter volume in the amygdala and thalamus relative to controls, highlighting distinct neurobiological patterns associated with the presence of the disease. This paper is centrally about endometriosis — specifically examining its association with voxel-based brain morphology and pain processing differences compared to non-endometriotic chronic pelvic pain.

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Abstract

Introduction Endometriosis is a chronic disease that may influence pain perception and brain neurobiology. It is unknown, whether these changes are caused by chronic pelvic pain (CPP) and/or comorbid mental disorders or endometriosis itself.
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Introduction

Endometriosis is a chronic disease that may influence pain perception and brain neurobiology. It is unknown, whether these changes are caused by chronic pelvic pain (CPP) and/or comorbid mental disorders or endometriosis itself.

Materials

& methods In this prospective study, we investigated psychological characteristics, thermal pain perception and brain gray matter volume (GMV) via MRI in women with CPP in the absence (n=21) and presence (n=23) of endometriosis in comparison to healthy controls (n=20). Whole brain GMV and regions of interest (ROI) were analyzed.

Results

The groups were comparable with respect to demographics and thermal pain perception. Up to 70%, women with CPP with and without endometriosis reported on previous mental comorbidities. Compared to the CPP group, endometriosis patients had a trend towards increased GMV in several brain regions including inferior temporal and superior medial gyrus, mid- and anterior cingulate cortex (MCC & ACC), p<0.05, and significantly higher GMV in the frontal medial cortex and the cingulate gyrus (p<0.05) in the ROI analyses. Further, they demonstrated increased GMV in the supplementary motor cortex (p<0.05) in contrast to healthy controls. CPP patients without endometriosis had decreased GMV in the amygdala and thalamus (p<0.05) in comparison to the control group. Pain itself and pain perception as well as mental comorbidities were also associated with neurobiological changes. Summary Women with endometriosis demonstrated GMV alterations associated with pain processing and executive functioning, potentially specific for endometriosis brain. However, pain and mental comorbidities are likely to be involved in shaping of those brain regions. Publication History Article published online: 11 October 2022 © 2022. Thieme. All rights reserved. Georg Thieme Verlag Rüdigerstraße 14, 70469 Stuttgart, Germany

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endometriosischronic_pelvic_pain

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