Research explores nervous system pathways that heighten endometriosis pain

Researchers have secured US$3m to study how brain pain pathways influence endometriosis treatment outcomes, potentially explaining why 25 to 40 per cent of patients do not respond.

The project will use neuroimaging to identify brain signatures that could predict which patients benefit from surgery or hormonal treatment.

USC researchers Jason Kutch and Neda Jahanshad received the National Institutes of Health grant to investigate pain processing patterns in the brain.

The study aims to understand why some patients get lasting relief while others undergo multiple surgeries with limited success.

There is often little correlation between the amount of endometrial tissue and pain levels.

Some patients with extensive lesions report minimal pain, while others with little visible disease experience severe symptoms.

Kutch is an associate professor in the USC Division of Biokinesiology and Physical Therapy

The researcher said: “About 25 to 40 per cent of patients don’t get sustained relief from those interventions.

“That leads many people to undergo multiple surgeries with only limited success.”

The research focuses on central sensitisation, where the nervous system becomes overactive and amplifies pain signals.

This involves complex interactions between biological pain drivers and how the nervous system detects and interprets those signals.

Kutch said: “There’s growing recognition that chronic pain involves a complex interplay between biological pain drivers and how the nervous system detects and interprets those signals.

“One key concept is central sensitisation, where the nervous system becomes overactive and amplifies pain.

“In this project, we’re trying to understand that component better: Can we predict who will respond to surgical or hormonal treatment, and who may not?”

The project builds on Kutch’s 14 years studying pelvic pain conditions, including bladder and prostate pain, where brain markers suggesting central sensitisation have been identified.

Jahanshad, associate professor of neurology and biomedical engineering at the Keck School of Medicine of USC, will harmonise independently collected datasets to explore different aspects of pelvic pain and treatment outcomes.

Jahanshad said: “My team specialises in merging different types of data that were collected independently and finding ways to harmonise them.

“The goal is to see whether there are brain signatures, before treatment, that can help predict who will respond successfully.

“We often see that some patients experience pain relapse after treatment or have coexisting conditions such as depression or anxiety that may influence their pain outcomes.

“We are looking to build a model that can help optimise treatment plans for women with endometriosis.” said

The researchers emphasised this is not about dismissing pain as psychological but understanding biological differences in brain pain processing.

Potential interventions could include non-invasive brain stimulation, which Kutch is currently trialling for interstitial cystitis, a related bladder pain condition.

Centrally acting medicines might also prove more effective if patients likely to benefit can be identified.