Mindfulness intervention effect on endometriosis-related pain dimensions and its mediator role on stress and vitality: a path analysis approach.

Endometriosis-related pain is supposedly mainly responsible for generating psychological stress and deteriorating the quality of life. However, the interaction between these factors has not been investigated, considering its multidimensional nature and through the path of effects of psychosocial approaches. The present study aims to investigate the effect of a brief mindfulness-based intervention (bMBI) on pain dimensions and its mediator role on psychological stress and QoL-Vitality improvement. A secondary analysis of a pilot randomized controlled trial using a series of parallel and serial mediators was carried out. The results showed that bMBI improves the sensory (B = -6.09 [-9.81, -2.52], ß = -0.42) and affective (B = -3.40 [-5.02, -1.80], ß = -0.47) pain. The bMBI effect on psychological stress reduction was mediated by these changes in sensory (B = -2.81 [-6.06, -0.41], ß = -0.21) and affective (B = -1.97 [-5.07, -0.17], ß = -0.15) pain. Serial sensory pain and psychological stress reduction (B = 2.27 [0.11, 5.81], ß = -0.09) mediated the bMBI effect on quality of life vitality. Meditation training promotes additional improvement in affective and sensory pain characteristics through which psychological stress is reduced. The sensory pain dimension must be positively impacted in combination with psychological stress for the bMBI improves women's vitality. Adding a psychosocial intervention like meditation training to the standard treatment plan may be required for some women to achieve the needed changes to restore well-being.

Cognitive-affective changes mediate the mindfulness-based intervention effect on endometriosis-related pain and mental health: A path analysis approach.

BACKGROUND: There is poor knowledge about the therapeutic mechanisms of the conservative interventions for endometriosis. We hypothesized that the effects of a brief mindfulness-based intervention (bMBI) on pelvic pain intensity (PPI), pain unpleasantness (PU) and quality of life mental health (QoL-MH) are mediated by direct and indirect paths of changes in pain catastrophizing (PC), positive affect (PA) and negative affect (NA). METHODS: A secondary analysis of a pilot randomized controlled trial of women with endometriosis, assigned to standard medical treatment (n = 32) and standard medical treatment plus bMBI (n = 31). We tested a series of parallel and serial mediators (PC, PA and NA) of the relationship between bMBI and outcomes (PPI, PU and QoL-MH). RESULTS: The bMBI group demonstrated improvement in PA (Cohen's f2 = 0.12 [0.01, 0.36]), decreases in NA (Cohen's f2 = 0.06 [0.00, 0.24]) and PC (Cohen's f2 = 0.16 [0.02, 0.42]). The PC reduction mediated the effect of the bMBI on PPI and PU directly; however, the PC effect through PA increase mediated the PU marginally but not PPI changes. bMBI effect on Qol-MH was mediated directly by PA and NA. The PC improved Qol-MH through PA increase and Pain decrease but not via NA. CONCLUSIONS: Our findings showed that bMBI impacts pain through changes in pain-related cognitive-affective factors. bMBI can improve QoL-MH by multiple pathways, including but not limited to pain reduction, highlighting the independent potential of improvement in affect to restore mental health in endometriosis. SIGNIFICANCE: Brief mindfulness-based intervention improves endometriosis pain through pain-related cognitive-affective factors and quality of life mental health via pain and affect changes unrelated to pain.

A single-blind, randomized, pilot study of a brief mindfulness-based intervention for the endometriosis-related pain management.

BACKGROUND: Women with endometriosis suffer from frequent symptoms despite multiple treatments in tertiary care. Although there is a need for a biopsychosocial perspective on endometriosis treatment, few conservative treatments have been investigated. We aimed to investigate the effects of a brief Mindfulness-Based Intervention (bMBI) in women with deep endometriosis who remain symptomatic despite undergoing conventional medical treatment. METHODS: A randomized controlled trial was performed with two groups: a standard medical treatment plus bMBI program and only standard medical treatment as a control. A total of 63 eligible participants were randomized to bMBI and control groups. The primary outcome was endometriosis-related pain, and secondary outcomes were quality of life and stress perception post-treatment. Analyses were carried out using multiple regression models. RESULTS: The results show that bMBI significantly improved pain unpleasantness (Cohen's f2  = 0.67, NNT = 3.2), pelvic pain (Cohen's f2  = 0.16, NNT = 5.3) and dyschezia (Cohen's f2  = 0.23, NNT = 2.9) immediately post-treatment and decreased all endometriosis-related pain (Cohen's f2 ranging from 0.20 to 0.60 and NNT ranging from 5 to -9) after the follow-up. We found an extensive positive effect of bMBI on the mental health dimension in the two time point measures (Cohen's f2  = 0.34 and 0.25, NNT = 3.5 and 2.3) and vitality (Cohen's f2  = 0.22, NNT = 2.1) after the follow-up. CONCLUSIONS: Our study suggests that bMBI is useful for managing endometriosis-related pain and restoring women's psychological well-being. SIGNIFICANCE: Brief Mindfulness-Based Intervention (bMBI) improved endometriosis-related pain and mental health compared to standard medical care. The present findings contribute to the applicability of MBI in visceral pain patients.

Association between severity of pain, perceived stress and vagally-mediated heart rate variability in women with endometriosis.

Chronic pelvic pain is the main symptom in women with endometriosis. Evidence suggests that psychological stress and autonomic regulation contribute to symptoms and pathophysiological modulation. We investigated the relationship between endometriosis-related pain severity, perceived stress, and autonomic balance in a sample of 81 women suffering chronic pelvic pain with deep endometriosis. Perceived stress and pelvic pain symptoms were assessed using the 10-item version of the Perceived Stress Scale (PSS-10) and the Numeric Pain Rating Scale (NPRS), respectively. Autonomic nervous system regulation was evaluated using vagally mediated components of the heart rate variability (vmHRV). Our results showed that pain unpleasantness and perceived stress were positively correlated, and women with mood disorders had higher perceived stress. The women with low resting vmHRV experience more intense pelvic pain, pain unpleasantness, and a higher number of severe endometriosis-related pain descriptors. The positive association between perceived stress, mood disorder, and pain unpleasantness demonstrates the additive effect between these aversive experiences. The inverse association between parasympathetic tone and pain suggests contributions of the Descending Inhibitory Pain pathway efficiency to symptom severity in women with endometriosis.

Efectividad de la relajacion fisica y mental en pacientes con hipertension inducida por el embarazo / Effectiveness of physical and mental relaxation in patients with pregnancy induced by hypertension

Estudio clinico experimental realizado en 15 mujeres con 22-42 semanas de embarazo y diagnostico hipertension inducida por el embarazo, sin historia de enfermedad cardiovascular o renal que no se encontraban en la fase aguda de la enfermedad, pero estaban hospitalizadas en el Hospital Regional Simon Bolivar de Bogota. Durante el estudio entre Febrero y Julio de 1989, como complemento del tratamiento medico-farmacologico, la enfermera implemento en el cuidado tecnicas de relajacion 2 veces durante un solo dia. Se evaluaron los niveles de ansiedad mediante el test de Hamilton, la presion arterial y las frecuencias cardiacas maternas y fetales como indicadores de la eficacia de este manejo en la reduccion de estres, considerado como factor predisponente o agravante de esta complicacion del embarazo. Las mujeres en quienes se realizo el estudio tenian entre 22 y 33 anos, a 10 de ellas se les habia hecho diagnostico de preeclampsia leve, a 4 de preeclampsia grave y a 1 de eclampsia. 9 eran primigestantes y 6 multigestantes. Antes de la relajacion la presion arterial sistolica se encontro entre 190 y 120 mm de Hg. y la diastolica entre 130-80 mm de Hg. comparativamente con las mediciones posteriores. Se evidencio disminucion mayor en la presion arterial diastolica continuado hasta 6 horas despues en el 13.3 por ciento . La ansiedad detectada en el 46.6 por ciento disminuyo o desaparecio inmediatamente despues del tratamiento. Las frecuencias cardiacas maternas y fetales no se aumentaron significativamente, por el contrario se mantuvo constante (mama) y en el 86.6 por ciento de los bebes. 6 ..