Journal of Pain Research (Nov 2020)
Commentary: Novel Use of Offset Analgesia to Assess Adolescents and Adults with Treatment Resistant Endometriosis-Associated Pain
Abstract
Claire E Lunde, 1– 3,* Edina Szabo, 1, 4,* Scott A Holmes, 1, 4 David Borsook, 1, 4 Christine B Sieberg 1, 2, 5 1Center for Pain and the Brain (P.A.I.N. Group), Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA; 2Biobehavioral Pediatric Pain Lab, Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Boston, MA, USA; 3Nuffield Department of Women’s and Reproductive Health, Medical Sciences Division, University of Oxford, Oxford, Oxfordshire, UK; 4Department of Anesthesiology, Harvard Medical School, Boston, MA, USA; 5Department of Psychiatry, Harvard Medical School, Boston, MA, USA*These authors contributed equally to this workCorrespondence: Christine B SiebergBiobehavioral Pediatric Pain Lab, Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, 21 Autumn St, Boston, MA, USATel +1 617-355-2296Email [email protected] and Objective: Endometriosis, affecting approximately 176 million adults and adolescents worldwide, is a debilitating condition in which uterine tissue grows outside the uterus. The condition costs the US economy approximately $78 billion annually in pain-related disability. By understanding the neural underpinnings of endometriosis-associated pain (EAP) and risk factors for chronification, translational research methods could lessen diagnostic delays and maximize successful pain remediation. This can be accomplished by the novel use of a known method, offset analgesia (OA), to better elucidate the neural mechanisms that may contribute to and maintain EAP. This commentary will provide justification and rationale for the use of OA in the study of EAP.Conclusion: Utilizing an OA paradigm in patients with endometriosis, especially adolescents, may (1) provide insight into neural mechanisms contributing to pain maintenance, which could capture those at-risk for the transition to chronic pelvic pain, (2) provide a metric for the development of future centrally mediated treatment options for this population, and (3) elucidate the brain changes that result in resistance to treatment and pain chronification.Keywords: endometriosis, chronic pain, offset analgesia, central nervous system
