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Cognitive-affective changes mediate the mindfulness-based intervention effect on endometriosis-related pain and
Marcelo de França Moreira1, Olga Lucia Gamboa2,3, Marco Aurelio Pinho Oliveira4
1State University of Rio de Janeiro, Faculty of Medical Sciences, Rio de Janeiro, RJ, Brazil.
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.
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