Phenotyping Responses to Optimize the Management of Pain Treatment in Endometriosis

表型反应以优化子宫内膜异位症疼痛治疗的管理

• 批准号: 10705003
• 负责人: Meryl Joseph Alappattu
• 金额: $ 19.06万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10705003
• 关键词: Ablation; Address; Adhesions; Affect; Aftercare; Age; Agonist; American College of Obstetricians and Gynecologists; Anatomy; Behavioral; Caring; Characteristics; Chronic; Clinical; Clinical Practice Guideline; Diagnosis; Diagnostic; Disease; Dysmenorrhea; Economics; Endometrial; Estrogens; Ethnic Origin; Excision; Female Genital Diseases; Foundations; Future; Gonadotropin Hormone Releasing Hormone; Guidelines; Health; Healthcare; Hemorrhage; Heterogeneity; Infertility; Laparoscopy; Lesion; Measures; Medical; Menarche; National Institute of Child Health and Human Development; Non-Steroidal Anti-Inflammatory Agents; Observational Study; Operative Surgical Procedures; Oral Contraceptives; Ovarian Mass; Pain; Pain intensity; Pain management; Pain quality; Pathogenesis; Patients; Pelvic Pain; Persistent pain; Pharmaceutical Preparations; Phenotype; Physical activity; Positioning Attribute; Postoperative Pain; Precision Medicine Initiative; Prediction of Response to Therapy; Predictive Value; Premenopause; Prevalence; Progestins; Prognosis; Progressive Disease; Provider; Quality of life; Race; Recommendation; Reporting; Risk Factors; Severities; Severity of illness; Strategic Planning; Subgroup; Symptoms; Therapeutic; Time; Tissues; Treatment Failure; Treatment outcome; United States; Uterine hemorrhage; Uterus; Variant; Woman; Work; aged; care burden; care seeking; central sensitization; chronic pelvic pain; clinical care; clinical pain; comorbidity; disabling symptom; disease phenotype; dosage; endometriosis; high reward; innovation; novel; opioid therapy; opioid use; pain outcome; pain reduction; pain relief; patient subsets; pharmacologic; precision medicine; prospective; psychologic; psychological distress; recruit; reproductive; response; sleep quality; sociodemographic variables; sociodemographics; success; symptom management; symptomatology; treatment response

PROJECT SUMMARY/ABSTRACT Endometriosis is a debilitating and progressive disease that affects 10% of reproductive-aged women. Characterized by the presence of endometrial lesions outside of the uterus, endometriosis is associated with chronic pelvic pain, bleeding, and infertility, with pain being the most debilitating symptom for which patients seek care. Endometriosis results in tremendous economic and healthcare burden and greatly impacts quality of life. Clinical practice guidelines for endometriosis recommend six months of conservative medical treatment for suppression of local or systemic estrogen levels; however, substantial variation exists in the degree of pain relief obtained from pharmacological therapy and some women subsequently require surgical removal of lesions, suggesting that heterogeneity in disease and symptom presentation may underlie treatment response. Further, the mechanisms that predict treatment failure and/or success are poorly characterized, thereby leaving providers in a position of long-term symptom management and with little guidance regarding therapies that may achieve the greatest efficacy. Quantifying this heterogeneity and identifying treatment response characteristics may be a crucial step toward individualizing therapeutic approaches for endometriosis to reduce overall pain burden. In line with the Precision Medicine Initiative, the aims of this prospective observational study are to explore mechanisms associated with treatment response in patients undergoing guideline-based conservative medical therapy for endometriosis, and to characterize associations between phenotypic profiles with pelvic pain severity and pain impact trajectories. Premenopausal women ages 18 to 45 years with clinically suspected endometriosis will be recruited and followed for a period of six months after undergoing conservative treatment according to the American College of Obstetricians and Gynecologists clinical practice guidelines. Heterogeneity in pre- treatment endometriosis symptom presentation will be quantified across the following measures: (1) sociodemographic, (2) clinical, (3) biomedical, (4) pain quality, (5) behavioral, (6) psychological, and (7) functional health. Patients will be followed monthly for six months to assess pelvic pain severity and pain impact. Collectively, these aims have the potential to advance our understanding of phenotypic mechanisms underlying conservative treatment response among women with endometriosis, effects which may serve as a foundation for reducing unnecessary and ineffective medical treatments and lessening the time to proper diagnosis and treatment.

项目摘要/摘要 子宫内膜异位症是一种令人衰弱和进行性疾病，影响了10％的生殖妇女。 子宫内膜异位症具有子宫内膜病变的特征 慢性骨盆疼痛，出血和不育，疼痛是患者寻求的最令人衰弱的症状 关心。子宫内膜异位症会导致巨大的经济和医疗保健负担，并极大地影响生活质量。 子宫内膜异位症的临床实践指南建议六个月的保守医疗治疗 抑制局部或全身雌激素水平；但是，疼痛缓解程度存在很大的变化 从药理学疗法获得的，一些妇女随后需要手术去除病变， 表明疾病和症状表现中的异质性可能是治疗反应的基础。更远， 预测治疗失败和/或成功的机制的特征很差，从而离开了提供者 在长期症状管理的位置，几乎没有关于可能实现的疗法的指导 最大的功效。量化这种异质性并确定治疗反应特征可能是 朝个性化治疗方法的关键步骤，以减轻总体疼痛负担。在 与Precision Medicine Initiative有关，这项前瞻性观察性研究的目的是探索 接受基于指南的保守医学的患者中与治疗反应相关的机制 用于子宫内膜异位症的治疗，并表征与骨盆疼痛严重程度的表型特征之间的关联 和疼痛影响轨迹。青春期妇女18至45岁，临床怀疑子宫内膜异位症 经过保守治疗后，将招募并遵循六个月的时间 美国妇产科学院临床实践指南。预 - 治疗子宫内膜异位症症状表现将在以下措施中进行量化：（1） 社会人口统计学，（2）临床，（3）生物医学，（4）疼痛质量，（5）行为，（6）心理学和（7） 功能健康。将每月遵循六个月的患者，以评估骨盆疼痛的严重程度和疼痛影响。 总的来说，这些目标有可能提高我们对表型机制的理解 子宫内膜异位症女性的保守治疗反应，可能是基础的作用 减少不必要和无效的医疗治疗，并减少适当诊断的时间 治疗。

项目成果

Presence of endometriosis and chronic overlapping pain conditions negatively impacts the pain experience in women with chronic pelvic-abdominal pain: A cross-sectional survey.

子宫内膜异位症和慢性重叠疼痛状况的存在会对慢性盆腹痛女性的疼痛体验产生负面影响：一项横断面调查。

• DOI: 10.1177/17455057241248017
• 发表时间: 2024
• 期刊: Women's health (London, England)
• 作者: Bartley,EmilyJ;Alappattu,MerylJ;Manko,Kelsey;Lewis,Hannah;Vasilopoulos,Terrie;Lamvu,Georgine
• 通讯作者: Lamvu,Georgine