Psychotherapy along with with somatosensory stimulation — tactile stimulus presented at a fixed rhythm — can reduce global pain, pelvic pain, and difficulty in defecating, and improve quality of life in patients with endometriosis, according to a study published in the medical journal Obstetrics and Gynecology.
The authors of the research paper “Psychotherapy With Somatosensory Stimulation for Endometriosis-Associated Pain” concluded that their results emphasize the importance of psychological factors in chronic endometriosis-associated pain.
“Psychotherapeutic treatment approaches should be considered for endometriosis whenever a patient experiences chronic pelvic pain despite previous pharmacologic or surgical treatments or when a patient wishes to discontinue hormonal suppressive drugs as a result of side effects or the desire to have a child,” the authors wrote. They added that a combination of psychotherapy and somatosensory stimulation could be particularly useful in such cases.
The team, led by Dr. Florian Beissner of the Institute for Neuroradiology at Hannover Medical School in Germany, randomly allocated 67 women, ages 18-40, with a history of endometriosis and chronic pelvic pain to either receive psychotherapy with somatosensory stimulation or join a three-month waiting list before receiving any treatment.
The treatment combined elements of mindfulness-based psychotherapy, hypnotherapy, problem-solving therapy, and cognitive-behavioral therapy as well as techniques of somatosensory stimulation from traditional Chinese medicine such as acupuncture; moxibustion, which consists of burning dried mugwort on particular points on the body; and cupping.
The researchers assessed the outcome of the treatments by analyzing brain connectivity related to pain and emotions by magnetic resonance imaging (MRI). They also used validated 11-point numeric rating scales ranging from 0 (no pain) to 10 (worst possible pain) to assess pain; the 12-item short-form health survey to assess quality of life; and validated questionnaires to assess functional well-being, depression, and anxiety.
The results showed that treated patients showed improvements after three months in their maximal global pain, average global pain, pelvic pain, difficulty in defecating, and physical and mental quality of life, compared to those on the waiting list.
The improvements in the treated group remained stable at six and 24 months. Patients who were treated following the three-month waiting period also showed comparable symptom relief following treatment.
The authors note that nonspecific effects may have contributed to the improvement of symptoms due to the healthcare professional delivering a high amount of confidence, trust, and empathy toward the patients. This emphasizes the role of psychological factors in chronic endometriosis-associated pain, as has been suggested in previous research.
The trial is registered under the number NCT01321840.