Efficacy of an environmental enrichment intervention for endometriosis: a pilot study

Abstract

IntroductionWe have previously shown that Environmental Enrichment (EE), a multi-modal psychosocial intervention consisting of increased social interaction, novelty, and open spaces, improved disease presentation, anxiety, and immune-related disturbances in the rat model of endometriosis. However, there is a knowledge gap regarding the effects of EE interventions in patients with this painful, inflammatory chronic disease.AimTo adapt and test the efficacy of an EE intervention on pelvic pain, mental health, perceived stress, quality of life, and systemic inflammation in endometriosis patients through a randomized clinical trial (RCT).Materials and methodsA multidisciplinary team with expertise in physiology, neuroscience, psychology, and women’s health adapted and implemented a two-arm RCT comparing an EE intervention with a wait-list control group. Six EE modules administered on alternate weeks were provided to patients in the intervention (N = 29); controls received education only. Survey data and biospecimens were collected at baseline, end-of-study, and 3-months post-intervention to assess pain (Brief Pain Inventory, BPI), endometriosis-related quality of life-QoL (Endometriosis Health Profile-30, EHP30), anxiety (Generalized Anxiety Disorder 7, GAD7), depression (Patient Health Questionnaire for Depression 8, PHQ8), pain catastrophizing (Pain Catastrophizing Score, PCS), stress (Perceived Stress Scale-14, PSS14), and saliva cortisol levels (AM, PM).ResultsCompared to the wait-list controls, participants in the EE intervention showed significantly decreased GAD-7 scores at the end of the intervention and 3-month follow-up. Depression, perceived stress, and QoL improved at the 3-month follow-up compared to baseline. While pain levels did not improve, they significantly correlated with anxiety, depression, QoL and pain catastrophizing scores.ConclusionThis pilot RCT demonstrated significant improvements in anxiety and depressive symptoms, QoL, and perceived stress, supporting enriched environments as an integrative psychosocial intervention to be used as adjuvant to the standard of care for endometriosis pain.

Pain and daily interference among reproductive-age women with myofascial pelvic pain: Serial mediation roles of kinesiophobia, self-efficacy and pain catastrophizing

“…40.52% of MFPP patients had been categorized as “extreme catastrophizing” in our study, which was similar to the results of previous studies conducted among women with endometriosis in 2022 (40.74%), and women with chronic pelvic pain in 2015 (44.02%) [ 9 , 28 ]. Despite the potential bidirectional link between pain and pain catastrophizing, a review of the basic neuroscience processes of pain suggests the stronger effect is pain predicting pain catastrophizing in clinical diagnostic pain conditions that were different from “psychogenic pain”, the direction tested in and supported by the current study [ 29 ].…”

“…In line with the previous researches [6,26,27], this study findings reveal that pain catastrophizing showed strong and consistently significant influential role in the association between pain and daily interference, while kinesiophobia and self-efficacy have no independently mediating effect. 40.52% of MFPP patients had been categorized as "extreme catastrophizing" in our study, which was similar to the results of previous studies conducted among women with endometriosis in 2022 (40.74%), and women with chronic pelvic pain in 2015 (44.02%) [9,28]. Despite the potential bidirectional link between pain and pain catastrophizing, a review of the basic neuroscience processes of pain suggests the stronger effect is pain predicting pain catastrophizing in clinical diagnostic pain conditions that were different from "psychogenic pain", the direction tested in and supported by the current study [29].…”

Environmental enrichment: a systematic review on the effect of a changing spatial complexity on hippocampal neurogenesis and plasticity in rodents, with considerations for translation to urban and built environments for humans

“…On the other hand, there are already validated psychometric tools that can be utilized for evaluating the effects of EE in daily human life, such as the Florida Cognitive Activities Scale (FCAS), the Multidimensional Social Integration in Later Life Scale (SILLS), and the International Physical Activity Questionnaire (IPAQ) ( Flores-Ramos et al, 2022 ), along with the Generalized Anxiety Disorder 7 (GAD-7) inventory ( De Hoyos et al, 2023 ). Notably, these psychometric studies have measured cognitive, social, and physical activities, but not the spatial complexity of life environments ( Flores-Ramos et al, 2022 ), further underscoring the gap in the literature.…”

“…Notably, these psychometric studies have measured cognitive, social, and physical activities, but not the spatial complexity of life environments ( Flores-Ramos et al, 2022 ), further underscoring the gap in the literature. Other studies have concentrated on social support, novelty, and open spaces as correlates of anxiety in patients with endometriosis and other inflammatory, painful disorders ( De Hoyos et al, 2023 ; Nieves-Vázquez et al, 2023 ), validating the use of GAD-7 while focusing on a different scope of EE. The National Center for Health Statistics (NCHS) in the United States employed a shorter version of the GAD-7, the GAD-2, along with the short form of the Patient Health Questionnaire (PHQ-2), to explore depression symptoms during the COVID-19 lockdown.…”