TY - JOUR

T1 - Psychological interventions improve quality of life despite persistent pain in endometriosis

T2 - results of a 3-armed randomized controlled trial

AU - Hansen, K. E.

AU - Brandsborg, B.

AU - Kesmodel, U. S.

AU - Forman, A.

AU - Kold, M.

AU - Pristed, R.

AU - Donchulyesko, O.

AU - Hartwell, D.

AU - Vase, L.

N1 - Publisher Copyright: © 2023, The Author(s).

PY - 2023/6

Y1 - 2023/6

N2 - Purpose: Despite standard medical treatment endometriosis is often associated with disabling pain and poor quality of life (QoL). Studies indicate that psychological interventions (PIs) may improve pain and QoL, yet studies on the effects of PIs for women with endometriosis are sparse and limited by low-quality study designs. Therefore, this study aimed, in a rigorous three-armed design, to evaluate the effect of PIs on chronic pelvic pain (CPP) and QoL in women with endometriosis. Methods: This three-armed parallel, multi-center randomized controlled trial included fifty-eight endometriosis patients reporting severe CPP [≥ 5 for pain intensity measured on a 0–10-point numeric rating scale (NRS)]. Patients were randomly assigned to (1) Specific mindfulness- and acceptance-based psychological intervention (MY-ENDO), (2) Carefully matched non-specific psychological intervention (Non-specific), or (3) A wait-list control group (WL). The primary outcome was pelvic pain intensity/unpleasantness measured on NRS. Secondary outcomes included endometriosis-related quality of life, workability, pain acceptance, and endometriosis-related symptoms. Differences in outcomes between groups at post-treatment follow-up were analyzed using mixed linear models. Analyses were performed on an intention-to-treat basis. Results: Compared to WL, psychological intervention (MY-ENDO + Non-specific) did not significantly reduce pain. However, psychological intervention did significantly improve the QoL-subscales ‘control and powerlessness’, ‘emotional well-being’, and ‘social support’ as well as the endometriosis-related symptoms ‘dyschezia’ and ‘constipation’. MY-ENDO was not superior to Non-specific. Conclusions: Women with endometriosis may have significant and large effects of psychological intervention on QoL despite an ongoing experience of severe CPP. Trial registration: 12 April 2016, clinicaltrials.gov (NCT02761382), retrospectively registered.

AB - Purpose: Despite standard medical treatment endometriosis is often associated with disabling pain and poor quality of life (QoL). Studies indicate that psychological interventions (PIs) may improve pain and QoL, yet studies on the effects of PIs for women with endometriosis are sparse and limited by low-quality study designs. Therefore, this study aimed, in a rigorous three-armed design, to evaluate the effect of PIs on chronic pelvic pain (CPP) and QoL in women with endometriosis. Methods: This three-armed parallel, multi-center randomized controlled trial included fifty-eight endometriosis patients reporting severe CPP [≥ 5 for pain intensity measured on a 0–10-point numeric rating scale (NRS)]. Patients were randomly assigned to (1) Specific mindfulness- and acceptance-based psychological intervention (MY-ENDO), (2) Carefully matched non-specific psychological intervention (Non-specific), or (3) A wait-list control group (WL). The primary outcome was pelvic pain intensity/unpleasantness measured on NRS. Secondary outcomes included endometriosis-related quality of life, workability, pain acceptance, and endometriosis-related symptoms. Differences in outcomes between groups at post-treatment follow-up were analyzed using mixed linear models. Analyses were performed on an intention-to-treat basis. Results: Compared to WL, psychological intervention (MY-ENDO + Non-specific) did not significantly reduce pain. However, psychological intervention did significantly improve the QoL-subscales ‘control and powerlessness’, ‘emotional well-being’, and ‘social support’ as well as the endometriosis-related symptoms ‘dyschezia’ and ‘constipation’. MY-ENDO was not superior to Non-specific. Conclusions: Women with endometriosis may have significant and large effects of psychological intervention on QoL despite an ongoing experience of severe CPP. Trial registration: 12 April 2016, clinicaltrials.gov (NCT02761382), retrospectively registered.

KW - Acceptance and commitment therapy

KW - Chronic pelvic pain

KW - Control condition

KW - Endometriosis

KW - Mindfulness

KW - Psychotherapy

KW - Quality of life

UR - http://www.scopus.com/inward/record.url?scp=85148112664&partnerID=8YFLogxK

U2 - 10.1007/s11136-023-03346-9

DO - 10.1007/s11136-023-03346-9

M3 - Journal article

C2 - 36797461

AN - SCOPUS:85148112664

VL - 32

SP - 1727

EP - 1744

JO - Quality of Life Research

JF - Quality of Life Research

SN - 0962-9343

IS - 6

ER -