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

1.Eisenberg, V. H., Decter, D. H., Chodick, G., Shalev, V., & Weil, C. (2022). Burden of Endometriosis: Infertility, Comorbidities, and Healthcare Resource Utilization. Journal of Clinical Medicine, 11(4), 1133. https://doi.org/10.3390/jcm11041133
2.Facchin, F., Barbara, G., Saita, E., Mosconi, P., Roberto, A., Fedele, L., & Vercellini, P. (2015). Impact of endometriosis on quality of life and mental health: Pelvic pain makes the difference. Journal of Psychosomatic Obstetrics and Gynecology, 36(4), 135–141. https://doi.org/10.3109/0167482X.2015.1074173
3.Facchin, F., Barbara, G., Dridi, D., Alberico, D., Buggio, L., Somigliana, E., Saita, E., & Vercellini, P. (2017). Mental health in women with endometriosis: Searching for predictors of psychological distress. Human Reproduction, 32(9), 1855–1861. https://doi.org/10.1093/humrep/dex249
4.Lorençatto, C., Petta, C. A., Navarro, M. J., Bahamondes, L., & Matos, A. (2006). Depression in women with endometriosis with and without chronic pelvic pain. Acta Obstetricia et Gynecologica Scandinavica, 85(1), 88–92. https://doi.org/10.1080/00016340500456118
5.Becker, C. M., Gattrell, W. T., Gude, K., & Singh, S. S. (2017). Reevaluating response and failure of medical treatment of endometriosis: a systematic review. Fertility and Sterility, 108(1), 125–136. https://doi.org/10.1016/j.fertnstert.2017.05.004
6.Dear, B. F., Titov, N., Perry, K. N., Johnston, L., Wootton, B. M., Terides, M. D., Rapee, R. M., & Hudson, J. L. (2013). The Pain Course: A randomised controlled trial of a clinician-guided Internet-delivered cognitive behaviour therapy program for managing chronic pain and emotional well-being. Pain, 154(6), 942–950. https://doi.org/10.1016/j.pain.2013.03.005
7.Dear, B. F., Gandy, M., Kdarin, E., Staples, L. G., Johnston, L., Fogliati, V. J., Wootton, B. M., Terides, M. D., Kayrouz, R., Perry, K. N., Sharpe, L., Nicholas, M. K., & Titov, N. (2015). The pain course: A randomised controlled trial examining an internet-delivered pain management program when provided with different levels of clinician support. Pain, 156(10), 1920–1935. https://doi.org/10.1097/j.pain.0000000000000251
8.Dear, B. F., Gandy, M., Karin, E., Ricciardi, T., Fogliati, V. J., McDonald, S., Staples, L. G., Perry, K. N., Sharpe, L., Nicholas, M. K., & Titov, N. (2017). The pain course: A randomised controlled trial comparing a remote-delivered chronic pain management program when provided in online and workbook formats. Pain, 158(7), 1289–1301. https://doi.org/10.1097/j.pain.0000000000000916
9.Dear, B. F., Karin, E., Fogliati, R., Dudeney, J., Nielssen, O., Gandy, M., Staples, L., Scott, A. J., Heriseanu, A. I., Bisby, M. A., Hathway, T., Titov, N., & Schroeder, L. (2022). The Pain Course: A randomised controlled trial and economic evaluation of an internet-delivered pain management program. Pain, 163(7), 1388–1401. https://doi.org/10.1097/j.pain.0000000000002507
10.Dear, B. F., Courtney, C., Khor, K. E., McDonald, S., Ricciardi, T., Gandy, M., Fogliati, V. J., & Titov, N. (2018). The Pain Course: Exploring the Feasibility of an Internet-delivered Pain Management Program When Offered by a Tertiary Pain Management Service. Clinical Journal of Pain, 34(6), 505–514. https://doi.org/10.1097/AJP.0000000000000565 https://doi.org/10.1016/j.jpain.2018.07.005
11.Friesen, L. N., Hadjistavropoulos, H. D., Schneider, L. H., Alberts, N. M., Titov, N., & Dear, B. F. (2017). Examination of an internet-delivered cognitive behavioural pain management course for adults with fibromyalgia: A randomized controlled trial. Pain, 158(4), 593–604. https://doi.org/10.1097/j.pain.0000000000000802
12.Gandy, M., Pang, S. T. Y., Scott, A. J., Heriseanu, A. I., Bisby, M. A., Dudeney, J., Karin, E., Titov, N., & Dear, B. F. (2022). Internet-delivered cognitive and behavioural based interventions for adults with chronic pain: A systematic review and meta-analysis of randomized controlled trials. Pain, 163(10), E1041–E1053. https://doi.org/10.1097/j.pain.0000000000002606

Presenting Author

Shianika Chandra

Poster Authors

Shianika Chandra

PhD (student)

Macquarie University

Lead Author

Blake Dear

PhD

Macquarie University

Lead Author

Madelyne Bisby

PhD(Psychology, MClinPsych, BPsych(Hons)

Macquarie University

Lead Author

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Abdominal and Pelvic Pain