![]() Here we report initial observations of a model, in which a section of uterus was autotransplanted to the sciatic nerve. To investigate this possibility, a rat model was designed based upon the common rat model of endometriosis, where a section of uterus is autotransplanted to other intraperitoneal structures ( Golan, 1987 Sharpe-Timms, 2002 Vernon & Wilson, 1985). We hypothesize that such a mechanism of radiating pain generation is also involved in endometriosis. These findings suggest that inflamed nerves are a source of pain perceived as coming from the nerve and as coming from the structure(s) that the nerve innervates. Furthermore, the sheaths of nerve trunks are innervated by mechanically and chemically-sensitive nociceptors ( Bove & Light, 1995a, b, 1997), which also participate in maintaining the local environment of the nerve ( Sauer et al., 1999). In an animal model, it has been shown that a focal inflammation of the sciatic nerve (called sciatic neuritis) evokes mechanical sensitivity in the axons of a subset of nociceptive (potentially pain-evoking) neurons without causing overt nerve damage ( Bove et al., 2003 Dilley & Bove, 2008 Dilley et al., 2005). Surgical descriptions of sciatic endometriosis describe inflammatory lesions that involve surrounding structures that are not necessarily otherwise diseased ( Descamps et al., 1995 Yekeler et al., 2004). Lumbar spinal investigations (myelogram, CSF analysis) are usually unremarkable, but magnetic resonance imaging can demonstrate larger lesions ( Binkovitz et al., 1991 Cottier et al., 1995 Yekeler et al., 2004). However, the symptom duration usually expands with endometriosis progression, developing into constant pain if left untreated.Įxamination findings in women with leg pain due to endometriosis are typical of sciatica due to other causes ( Torkelson et al., 1988), including painful straight leg raising testing, and may also include a diminished Achilles tendon reflex, mild muscular atrophy, and tenderness of the sciatic nerve at the sciatic notch. A consistent and thus perhaps key diagnostic feature seems to be the cyclical or catamenial nature of the symptom, especially earlier in the progression of the endometriosis ( Capek et al., 2016 Dhote et al., 1996 Moeser et al., 1990 Takata & Takahashi, 1994 Zager et al., 1998). Radiating leg pain related to the menstrual cycle has been reported as a complication of endometriosis in a number of case studies ( Baker et al., 1966 Bjornsson, 1976 Denton & Sherrill, 1955 Floyd et al., 2011 Forrest & Brooks, 1972 Head et al., 1962 Motamedi et al., 2015 Pacchiarotti et al., 2013), and in two surveys ( Missmer & Bove, 2011 Walch et al., 2014). Although prevalent, endometriosis remains neither readily diagnosed ( Hadfield et al., 1996) nor easily treated ( Attaran et al., 2002). Manual therapists should be aware of the possibility of endometriosis causing symptoms and examination findings that mimic musculoskeletal etiologies.Įndometriosis is defined by the presence of tissue resembling endometrium external to the uterus, and is associated with infertility, dysmenorrhea, and chronic pelvic pain ( Attaran et al., 2002 Berkley et al., 2005 Giudice & Kao, 2004 Halis & Arici, 2004). This model could shed light upon the radiating leg pain that often accompanies endometriosis. The persistent immune response and innervation suggest the nerve-uterus complexes as sources of inflammation and persistent neural discharge, and thus pain. Only 1 of 8 control rats developed a small cyst, presumably due to residual endometrium. Microscopically, the complexes contained recruited macrophages, indicating persistent inflammation, and were innervated by small diameter axons. Macroscopically, turgid cysts apposed to the nerves characterized the complexes. All autotransplants survived, resulting in a fusion of the uterus sections to the nerves. Control nerves were harvested after 4 months. After 1, 3, and 15 months the nerves were harvested and processed for immune cell presence and for neural elements. Uterus sections with the endometrium removed and autotransplanted to the sciatic nerve served as controls. ![]() To model sciatic endometriosis in female Wistar rats, a section of uterine horn was autotransplanted to the sciatic nerve. We hypothesized that endometrioma can induce nerve inflammation thus the radiating leg pain that often accompanies endometriosis. Patients with such pain often seek care from multiple health care professionals, including manual therapists. Endometriosis is a prevalent female health disorder that often leads to back pain and radiating leg pain.
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