Examining the efficacy and acceptability of an internet-delivered psychological pain management program for endometriosis

<p dir="ltr">Endometriosis is a chronic inflammatory condition characterised by the growth of endometrial-like tissue outside the uterine cavity and musculature. Chronic pain is the most common and distressing symptom of endometriosis and is associated with higher rates of depression and anxiety symptoms, functional impairment and worse quality of life. Current first line treatments for endometriosis include laparoscopic surgery and medical management, however, these treatments are not curative. Consequently, a meaningful proportion of patients will continue to experience persistent pain and its impacts on their mental health and day-to-day functioning. </p><p dir="ltr">Psychological interventions that promote coping and effective self-management of persistent pain may offer a promising adjunct to currently available medical care. While there is substantial evidence to support the efficacy of psychological interventions in other chronic pain conditions, very limited research has examined these interventions for endometriosis. Additionally, face-to-face psychological treatments are not widely available, and as is the case with most other conditions, patients face barriers to access timely and effective psychological care. Therefore, the overarching aim of the current thesis was to examine the efficacy and acceptability of a painfocused psychological intervention, delivered via the internet, in patients experiencing endometriosis-related pain. This was explored over three studies. </p><p dir="ltr">The first study evaluated the feasibility, acceptability and preliminary efficacy of an established, general, psychological pain management program for patients with endometriosis. As this program was designed for mixed chronic pain conditions, the current study specifically examined the data from the subset of participants (n = 78) who reported a diagnosis of endometriosis. The study reported high lesson completion and treatment satisfaction and preliminary evidence of efficacy. Specifically, relative to the control group, patients in the treatment group experienced significant improvements in depression, anxiety and pain-related disability from pretreatment to posttreatment. However, at the post-treatment timepoint, only the between group test for depression, but not anxiety or pain-related disability, reached statistical significance. It is likely that this latter finding resulted from low statistical power. </p><p dir="ltr">The second study was a two-arm randomised controlled trial that examined the efficacy and acceptability of an adapted version of the aforementioned internet-delivered intervention. Findings indicated that relative to control, patients in the treatment group experienced greater improvements in depression, anxiety and pain-related disability from pretreatment to post treatment. Improvements were maintained in the treatment group at 3-month follow-up. Importantly, the intervention was acceptable with high rates of lesson completion and satisfaction. </p><p dir="ltr">Finally, the third study explored the potential demographic, clinical, baseline symptom severity and psychological process factors associated with clinical response using data from the second study. An important finding was that higher baseline symptoms were generally associated with higher likelihood of clinical response (defined as ≥30% and ≥50% change). However, no demographic or clinical predictors were identified that were dominant or consistently predicted response. These findings supported the broad suitability of this intervention for a range of endometriosis patients. </p><p dir="ltr">Taken together, the current findings highlight the potential of a pain-focused psychological interventions to support the mental health and daily functioning of patients with endometriosis and the potential accessibility and scalability of the internet-delivered approach. While these findings are preliminary, they are nonetheless encouraging and indicate that future research is needed and worthwhile. Such research will have many important clinical and research implications to improve the nature of care provided to endometriosis patients.</p>