PAIN+ CPN

Limited research has examined psychological treatments for endometriosis-related chronic pain, despite its association with elevated disability, depression, and anxiety. Remotely delivered treatments have the potential to overcome barriers to access face-to-face psychological care, however, no studies have examined this format in endometriosis patients. The current study examined the efficacy and acceptability of an internet-delivered, psychological, pain management program for women with endometriosis-related pain. In this two-arm trial, 193 participants experiencing endometriosis-related pelvic pain were randomly assigned to the 8-week treatment or a waitlist control. The treatment was an adapted version of an established internet-delivered pain management program based on cognitive-behavior therapy principles. Relative to control, the treatment group reported significantly greater improvements (between groups Cohen's d; average percentage change) in the primary outcomes of pain-related disability (d = 0.35; 24%), depression (d = 0.40; 17%), and anxiety (d = 0.26; 17%) from pre- to post-treatment. Improvements were sustained at 3-month follow-up. No between-group difference was observed on the secondary outcome of average pain intensity (d = 0.28; 17%, P = 0.054). High lesson completion and treatment satisfaction rates were observed. Mean clinician time per participant was 70 minutes (SD = 68). The current findings indicate the potential of a pain-focused psychological approach in supporting endometriosis-related pain, and the potential of the internet-delivered format in increasing access to care. Future research is needed to examine long-term outcomes and investigate factors associated with optimal treatment response.

Physician rater

The study confirms meta-analytic findings of the efficacy of internet-delivered RCTs of psychological interventions in reducing pain-related disability and distress (but not pain intensity) for some chronic pain conditions. There has been a shift in gynecology to conceptualise endometriois-related pain within a biopsychosocial model and to offer multicomponent treatment beyond antihormonal therapy and surgery. The study supports using psychological methods for endometriosis-related pain. However, the study reproduces methodological problems of many studies with psychological therapies for chronic pain: The waiting list control is not an adequate control group. A comparison to optimised medication or physiotherapy would have been more appropriate. 64% of the women in the study group completed the last (5th) lesson. I do not agree with the authors`statement on a "high lesson completion."

No subscriber has commented on this article yet.