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

Marcelo de França Moreira; Olga Lucia Gamboa; Marco Aurelio Pinho Oliveira

doi:10.1002/ejp.2149

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

Eur J Pain. 2023 Nov;27(10):1187-1202. doi: 10.1002/ejp.2149. Epub 2023 Jun 26.

Authors

Marcelo de França Moreira¹, Olga Lucia Gamboa^{2

3}, Marco Aurelio Pinho Oliveira⁴

Affiliations

¹ State University of Rio de Janeiro, Faculty of Medical Sciences, Rio de Janeiro, RJ, Brazil.
² EQness, Sydney, New South Wales, Australia.
³ School of Psychology, A19 - Griffith Taylor Building, University of Sydney, Camperdown, New South Wales, Australia.
⁴ Department of Gynecology, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.

PMID: 37365715
DOI: 10.1002/ejp.2149

Abstract

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.