Background & Aims
Endometriosis is present in most women reporting chronic pelvic pain (1). Endometriosis-related pain is associated with higher rates of depressive and anxiety symptoms, poorer daily functioning, and overall quality of life (2,3,4). Current treatment options target pain via direct removal of the underlying disease pathology, however, this is not curative, and pain often recurs over time (5).
Given the chronicity of endometriosis-related pain and its impacts, there is a need to explore treatment options that support good mental health and functioning. Current psychological treatment options for endometriosis-related pain are limited and not widely accessible. Therefore, the current study investigated the efficacy and acceptability of an internet-delivered psychological pain management program designed to improve anxiety and depressive symptoms and support daily functioning among people with endometriosis-related pain.
Methods
This study is a randomised controlled trial (RCT) of a modified and tailored internet-delivered pain management program for endometriosis (6,7,8,9). Participants (target N = 160) are being randomised to immediate treatment (n = 80) or a waitlist control (n = 80). The 8-week program included 5 lessons and simple homework tasks consisting of practical worksheets and additional resources designed to teach psychological self-management skills. Each lesson provided important information about techniques for managing pain and emotional wellbeing, with illustrated examples of how people learned these techniques. Each lesson takes approximately 20 to 30 minutes to read and is provided with practice tasks. Participants had the option to work with a Clinical Psychologist (via telephone and secure messaging) alongside the online program.
Participants completed standardised questionnaires at three time-points: pre-treatment, post-treatment and three-month follow-up.
Results
This trial is ongoing with 154 of 160 (96%) participants recruited to date. Complete data and analyses will be presented at the conference. Multiple Imputation will be used to handle missing data and all analyses conducted using intention-to-treat principles. First, generalised estimating equations (GEE) will be used to examine change over time between the treatment and control groups on primary outcomes of pain-related disability, depression, and anxiety. GEE’s will also be used to explore change in average pain intensity and stability of outcomes to 3-month follow-up. Second, the proportions of participants making clinically significant improvements across the primary and secondary outcomes will be reported. Third, rates of treatment completion, participant satisfaction levels, and total clinician time used by participants will be reported. Finally, sensitivity analyses will explore participant outcomes based on pain-related disability, anxiety and depressive symptoms at baseline.
Conclusions
The results of this trial will provide novel data on the efficacy and acceptability of an internet-delivered psychological pain management program for participants experiencing endometriosis-related pain. There is now considerable and growing evidence for the efficacy and acceptability of these programs for people with a range of pain-related conditions (6,7,8,9,10,11,12). However, there is little or no evidence for people with endometriosis.
Further research will be needed to understand the factors, such as clinical or demographic variables, which may predict treatment response to optimise outcomes and our understanding of endometriosis-related pain.
References
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Presenting Author
Shianika Chandra
Poster Authors
Topics
- Specific Pain Conditions/Pain in Specific Populations: Abdominal and Pelvic Pain