leuprolide and Chronic-Pain

To demonstrate that adenomyosis is a rare cause of dysmenorrhea or chronic pelvic pain (CPP) in the adolescent population that can be identified with magnetic resonance imaging (MRI) and to report resolution of adenomyosis by MRI after a course of hormonal suppression in 4 adolescents.. Retrospective case series of 4 adolescents with adenomyosis on pelvic MRI at Texas Children's Hospital.. Continuous oral contraceptive (COC) therapy or leuprolide acetate.. Lesions on pelvic MRI after treatment.. We reviewed medical records of 4 adolescents with CPP and adenomyosis on T2-weighted pelvic MRI. All patients had initial diagnostic pelvic MRI and then definitive hormonal intervention. Repeat imaging was obtained after a symptom-free interval.. Patient ages ranged from 12 to 16 years. One patient had resolution of symptoms with COC therapy. MRI performed 3 years later showed no adenomyosis. Three patients failed COC therapy. All were symptomatically improved after therapy with a gonadotropin-releasing hormone agonist. Follow-up MRI performed at intervals between 6 months and 3 years showed resolution of adenomyosis.. MRI can raise suspicion for the diagnosis of adenomyosis in adolescents with refractory CPP. Subsequent MRI can show regression of lesions after symptom resolution with hormonal therapy.

Topics: Adenomyosis; Adolescent; Antineoplastic Agents, Hormonal; Child; Chronic Pain; Contraceptives, Oral; Dysmenorrhea; Endometriosis; Female; Gonadotropin-Releasing Hormone; Humans; Leuprolide; Magnetic Resonance Imaging; Pelvic Pain; Retrospective Studies; Texas; Treatment Outcome

The aim of this study was to evaluate the improvement in catamenial chronic pelvic pain (CPP) after Gonadotropin Releasing Hormone analogue (GnRH-a) administration in women affected by adenomyosis or endometriosis. We retrospectively analysed clinical data of 63 premenopausal women with clinical suspect of adenomyosis (15 women, Group A) or endometriosis (48 women, Group B), which received GnRH-a in order to reduce CPP intensity during the time on surgery waiting list. Main outcome measures were variation of CPP intensity, numbers of days requiring analgesics and lost work productivity before and three months after GnRH-a administration. Compared to baseline, a significant decrease in CPP intensity (p < 0.05) was observed in both groups, even if this reduction was significantly higher in Group A than in Group B (p < 0.001). In both groups, moreover, a significant reduction in number of days requiring analgesics (p < 0.05) and lost work productivity (p < 0.05) was detected. In conclusion, GnRH-a administration in women with clinical suspect of adenomyosis induces a greater reduction in CPP when compared to women with endometriosis, thus representing a potential ex adiuvantibus criteria, helping TV-US in the clinical diagnosis of adenomyosis.

Topics: Adenomyosis; Adult; Chronic Pain; Endometriosis; Female; Humans; Leuprolide; Middle Aged; Ovarian Diseases; Pelvic Pain; Retrospective Studies; Treatment Outcome

While chronic pain is a main symptom in endometriosis, the underlying mechanisms and effective therapy remain elusive. We developed an animal model enabling the exploration of ectopic endometrium as a source of endometriosis pain. Rats were surgically implanted with autologous uterus in the gastrocnemius muscle. Within two weeks, visual inspection revealed the presence of a reddish-brown fluid-filled cystic structure at the implant site. Histology demonstrated cystic glandular structures with stromal invasion of the muscle. Immunohistochemical studies of these lesions revealed the presence of markers for nociceptor nerve fibers and neuronal sprouting. Fourteen days after surgery rats exhibited persistent mechanical hyperalgesia at the site of the ectopic endometrial lesion. Intralesional, but not contralateral, injection of progesterone was dose-dependently antihyperalgesic. Systemic administration of leuprolide also produced antihyperalgesia. In vivo electrophysiological recordings from sensory neurons innervating the lesion revealed a significant increase in their response to sustained mechanical stimulation. These results are consistent with clinical and pathological findings observed in patients with endometriosis, compatible with the ectopic endometrium as a source of pain. This model of endometriosis allows mechanistic exploration at the lesion site facilitating our understanding of endometriosis pain.

Topics: 4-Aminopyridine; Action Potentials; Amifampridine; Animals; Antineoplastic Agents, Hormonal; Biophysics; Calcitonin Gene-Related Peptide; Cells, Cultured; Chronic Pain; Disease Models, Animal; Dose-Response Relationship, Drug; Electric Stimulation; Endometriosis; Endometrium; Estrous Cycle; Female; Ganglia, Spinal; GAP-43 Protein; Hyperalgesia; Lectins; Leuprolide; Muscle, Skeletal; Nerve Fibers; Patch-Clamp Techniques; Potassium Channel Blockers; Progesterone; Progestins; Rats; Rats, Sprague-Dawley; Sensory Receptor Cells; Tetraethylammonium; Time Factors; Transplants; Uterus