Interdisciplinary group care for the treatment of endometriosis-associated pain

PROJECT SUMMARY/ABSTRACT Endometriosis affects 10-15% of women, causing musculoskeletal pain, bowel and bladder problems, mood disorders, and infertility. Chronic pelvic pain is the most common symptom affecting 57.2% of patients. Endometriosis is responsible for an estimated $69.4 billion per year in excess health expenditures, and significant loss of workplace and household productivity. Current strategies to treat endometriosis, such as hormonal therapy or surgery, often fail to prevent recurrence and the associated pain. Therefore, we must develop, test, and implement new strategies to treat this condition. Given the broad impact of endometriosis- associated pelvic pain on multiple domains of life, we developed the Peer Empowered Endometriosis Pain Support (PEEPS) intervention that is comprised of three evidence-based approaches: interdisciplinary and integrated care delivered in a group care model. The PEEPS intervention was adapted from Chao et al.’s Centering Chronic Pelvic Pain group care program by our team of a physical therapist, yoga instructor, clinical psychologist, and endometriosis specialist. Adaptation was informed by implementation science and community engaged research methods. Through this process, we optimized PEEPS to an 8-session group care program that incorporates education on endometriosis, physical therapy, mindfulness, yoga, nutrition, and strategies to cope with chronic pain. We hypothesize that PEEPS will lead to decreased endometriosis-associated pain interference, improved quality of life, and decreased pain catastrophizing. To determine PEEPS preliminary effectiveness, I propose to perform a pilot single-site randomized controlled trial of PEEPS to education. I hypothesize that patients in PEEPS will show greater decrease in pain interference in daily activities than those in the education arm. With 30 patients in the PEEPS arm and 30 in the education arm, this pilot trial may be powered to detect an effect size of 0.8 based on the effectiveness of the intervention components. In parallel to the randomized controlled trial, we will evaluate barriers, facilitators, and implementability of PEEPS. Most research and evidence-based interventions never reach patients and clinical practice. As PEEPS is comprised of several effective interventions that have a high probability of synergistically improving participant symptoms, we will use an implementation science approach in order to understand how to most effectively translate PEEPS to real-world practice. I will use the data and experiences I gain in conducting this single-site randomized controlled trial to optimize PEEPS and apply for R01-level funding to scale up the intervention and perform a multi-site randomized controlled trial.