Pain Reduction with an Immersive Digital Therapeutic in Women Living with Endometriosis-Related Pelvic Pain: at-home self administered randomized controlled trial

Virtual reality-based pain control in endometriosis: a questionnaire-based pilot study of applications for relaxation and physical activity

PURPOSE

Virtual reality (VR) based technology may offer new avenues in the management of chronic endometriosis-related pain. Our prospective, 14-week, open, three-phase, cross-over pilot study investigated whether the use of VR technology equipped with a relaxation-inducing application (VR-R) or an activity-stimulating application (VR-A) could change endometriosis-related chronic pelvic pain levels and impairment of daily life.

METHODS

23 women aged 32.7 (SD 8.2) with endometriosis-related pelvic pain were each assigned to a permutated sequence of three 4-week phases: (A) the VR-R, (B) VR-A, and (C) intervention-free control phases. Phases were separated by two interspersed 1-week washout phases. Main outcome measures included: momentary, average, and maximum pain intensities on a 0-10 numerical rating scale (NRS); the Pain Disability Index (PDI) score; the Pain Catastrophizing Scale (PCS) score; sleep quality (Medical Outcomes Study Sleep Scale (MOS-SS) score); the Depression Anxiety Stress Scales (DASS) score; and the general health-related quality-of-life score (Short Form (12) Health Survey (SF-12)).

RESULTS

Compared to baseline, VR-R use showed statistically significant positive effects for several scores (NRS "average pain"; PDI "total score"; PCS "total score" and the "magnification", "rumination", and "helplessness" subscores; MOSS-SS "index I and II"; and the DASS "depression" and "stress" subscores), whereas VR-A yielded significant positive changes only for PDI "total score"; PCS "total score" and the "helplessness" and "magnification" subscores; MOSS-SS "index II"; and DASS "depression" and "stress". As four scale scores also showed significant improvements for control, a comparison of the effects was performed to offset a potential placebo-like effect by comparing difference from baseline against control. This analysis yielded significantly greater positive effects only for VR-R: PCS "total score" and "helplessness"; MOSS-SS "index I" and "index II"; and the three DASS subscores "depression", "anxiety", and "stress". SF-12 showed no significant changes in either analysis.

CONCLUSIONS

VR-R and VR-A showed positive effects on several pain and quality-of-life scores, which were significant for some scores compared to baseline. For VR-R, some of these improvements were indeed significantly greater than under control conditions, while the effects with VR-A were not. Larger studies are needed to corroborate these findings.

TRIAL REGISTRATION

DRKS00030189.

A Digital Program for Daily Life Management With Endometriosis: Pilot Cohort Study on Symptoms and Quality of Life Among Participants

BACKGROUND

After experiencing symptoms for an average of 7 years before diagnosis, patients with endometriosis are usually left with more questions than answers about managing their symptoms in the absence of a cure. To help women with endometriosis after their diagnosis, we developed a digital program combining user research, evidence-based medicine, and clinical expertise. Structured around cognitive behavioral therapy and the quality of life metrics from the Endometriosis Health Profile score, the program was designed to guide participants for 3 months.

OBJECTIVE

This cohort study was designed to measure the impact of a digital health program on the symptoms and quality of life levels of women with endometriosis.

METHODS

In total, 63% (92/146) of the participants were included in the pilot study, recruited either free of charge through employer health insurance or via individual direct access. A control group of 404 women with endometriosis who did not follow the program, recruited through social media and mailing campaigns, was sampled (n=149, 36.9%) according to initial pain levels to ensure a similar pain profile to participants. Questionnaires assessing quality of life and symptom levels were emailed to both groups at baseline and 3 months. Descriptive statistics and statistical tests were used to analyze intragroup and intergroup differences, with Cohen d measuring effect sizes for significant results.

RESULTS

Over 3 months, participants showed substantial improvements in global symptom burden, general pain level, anxiety, depression, dysmenorrhea, dysuria, chronic fatigue, neuropathic pain, and endo belly. These improvements were significantly different from the control group for global symptom burden (participants: mean -0.7, SD 1.6; controls: mean -0.3, SD 1.3; P=.048; small effect size), anxiety (participants: mean -1.1, SD 2.8; controls: mean 0.2, SD 2.5; P<.001; medium effect size), depression (participants: mean -0.9, SD 2.5; controls: mean 0.0, SD 3.1; P=.04; small effect size), neuropathic pain (participants: mean -1.0, SD 2.7; controls: mean -0.1, SD 2.6; P=.004; small effect size), and endo belly (participants: mean -0.9, SD 2.5; controls: mean -0.3, SD 2.4; P=.03; small effect size). Participants' quality of life improved between baseline and 3 months and significantly differed from that of the control group for the core part of the Endometriosis Health Profile-5 (participants: mean -5.9, SD 21.0; controls: mean 1.0, SD 14.8; P=.03; small effect size) and the EQ-5D (participants: mean 0.1, SD 0.1; controls: mean -0.0, SD 0.1; P=.001; medium effect size). Perceived knowledge of endometriosis was significantly greater at 3 months among participants compared to the control group (P<.001).

CONCLUSIONS

This study's results suggest that a digital health program providing medical and scientific information about endometriosis and multidisciplinary self-management tools may be useful to reduce global symptom burden, anxiety, depression, neuropathic pain, and endo belly while improving knowledge on endometriosis and quality of life among participants.

Endometriosis in Adolescence: A Narrative Review of the Psychological and Clinical Implications

Endometriosis is a chronic, inflammatory condition where endometrial-like tissue grows outside the uterus, affecting around 10% of women of reproductive age. This condition is associated with debilitating symptoms, including dysmenorrhea, dyspareunia, chronic pelvic pain, fatigue, and infertility. Adolescents with endometriosis face unique challenges, as the disease is often misdiagnosed or undiagnosed for an average of 7-10 years due to its complex and multifactorial nature. Consequently, patients frequently suffer from worsening symptoms and significant psychological distress, including anxiety, depression, and social withdrawal. While there is no definitive cure for endometriosis, treatment approaches typically involve hormonal therapies, lifestyle adjustments (such as diet and exercise), and psychological support. Recent studies emphasize the profound impact of endometriosis on the mental health of adolescents, highlighting the need for a more holistic treatment approach that integrates both medical and psychological care. This narrative review explores the psychological and psychosocial effects of endometriosis in adolescents, examining the biological and psychological mechanisms linking the disease to mental health outcomes. It also discusses current therapeutic strategies, such as cognitive behavioral therapy, mindfulness, and peer support, and underscores the importance of early diagnosis and multidisciplinary care to mitigate both the physical and emotional burdens of the condition. This integrated approach is critical in improving the overall well-being and quality of life for adolescents living with endometriosis.

Pelvic floor rehabilitation in cancer survivorship: an umbrella review

PURPOSE

This umbrella review aimed to identify, critically appraise, and summarize current systematic reviews with meta-analyses on the role of pelvic floor rehabilitation in cancer survivorship.

METHODS

Four bibliographic databases were searched from inception to August 1, 2024. Two independent reviewers screened the titles and abstracts of 379 records and retrieved 24 full-text systematic reviews. Assessing the Methodological Quality of Systematic Reviews-2 was used for quality assessment. Qualitative syntheses were performed to compile the effects of pelvic floor rehabilitation on bladder function, bowel function, quality of life, and other outcomes. Measures of effect sizes of these outcomes in each meta-analysis were extracted and summarized.

RESULTS

Seventeen systematic reviews with meta-analyses published between 2012 and 2024 were included in this umbrella review, containing a total of 92 primary studies. For quality assessment, four studies were evaluated as moderate quality, five as low, and eight as critically low. Populations with prostate, colorectal, and gynecological cancer were studied. Effects of pelvic floor rehabilitation on bladder, bowel, sexual function, and quality of life were reported and synthesized.

CONCLUSIONS

Pelvic floor rehabilitation is an essential component of cancer survivorship, including following prostate, colorectal, and gynecological cancer surgery. Further high-quality primary studies with adequate sample sizes are needed to inform clinical practice and research endeavors.

IMPLICATIONS FOR CANCER SURVIVORS

This umbrella review highlights the therapeutic potential of pelvic floor rehabilitation, underscores the need for its broader implementation in survivorship care, and guides future research directions to optimize outcomes for cancer survivors.

Effectiveness of Digital Health Interventions (DHI) in Chronic Pain Management: A Scoping Review of Current Evidence and Emerging Trends

This review aims to address the impact of digital health interventions (DHIs) on chronic pain management, specifically, mHealth, eHealth, wearable devices, virtual reality (VR), and artificial intelligence. The following study identifies and assesses DHIs' efficacy in specific chronic pain conditions and then extrapolates improved outcomes and patient groups that benefit from their use. Using a systematic methodology, this review synthesizes findings that could improve knowledge for patients and practitioners in chronic pain management while also addressing gaps in understanding the impact of DHIs. Sub-questions guide the identification of gaps and recommendations assessing DHIs' effectiveness for pain reduction and improved quality of life. A systematic search across databases (EMBASE, Ovid MEDLINE, CINAHL, Web of Sciences, Cochrane Central) targets original, English-language, peer-reviewed studies (2013-2023). The inclusion criteria cover DHIs in chronic pain management for adults age 18+, excluding non-full texts, reviews, opinion pieces, or unrelated articles. Search terms include "chronic pain management" OR "long-term pain relief strategies" OR "sustained pain alleviation" OR "pain control for chronic conditions" OR "chronic pain" AND "ehealth interventions" OR "mobile health interventions" OR "digital therapy" OR "health informatic solutions" OR "digital health intervention." After applying inclusion criteria, 34 articles from 11 countries are included, with studies conducted primarily in the United States (n = 17), United Kingdom (n = 4), and Australia (n = 3). DHIs are emerging as effective tools in pain management, as they can emphasize patient autonomy and communication with clinicians while enabling medical self-management in diverse populations. These various digital interventions show promise in reducing pharmaceutical usage and deferring surgical procedures, with most studies reporting positive outcomes in pain reduction. DHIs were also associated with positive mental health outcomes; however, some studies found no significant improvement. Additionally, interventions targeting pain catastrophizing showed varied results, with some app-based approaches demonstrating promise. Overall, the review underscores the potential of DHIs in improving chronic pain management outcomes.

Virtual Reality in Acute and Chronic Pain Medicine: An Updated Review

PURPOSE OF REVIEW

This review critically analyzes the recent literature on virtual reality's (VR) use in acute and chronic pain management, offering insights into its efficacy, applications, and limitations.

RECENT FINDINGS

Recent studies, including meta-analyses and randomized controlled trials, have demonstrated VR's effectiveness in reducing pain intensity in various acute pain scenarios, such as procedural/acute pain and in chronic pain conditions. The role of factors such as immersion and presence in enhancing VR's efficacy has been emphasized. Further benefits have been identified in the use of VR for assessment as well as symptom gathering through conversational avatars. However, studies are limited, and strong conclusions will require further investigation. VR is emerging as a promising non-pharmacological intervention in pain management for acute and chronic pain. However, its long-term efficacy, particularly in chronic pain management, remains an area requiring further research. Key findings highlight that VR programs vary in efficacy depending on the specificity of the origin of pain.

Research on disease management of chronic disease patients based on digital therapeutics: A scoping review

Background

The prevalence of chronic diseases is rising annually due to the aging of the population, and these illnesses constitute a major cause of mortality. Digital therapeutics (DTx) is a promising solution for the prevention and management of chronic diseases. With the rapid advancement of information technology in recent years, software algorithms or applications based on clinical assessment, evidence, and technology can be used to directly provide digital medical interventions to patients to promote disease management. Digital therapeutics has been applied in the field of various diseases. The most significant application area among them is the management, treatment, and intervention of chronic illnesses.

Objectives

To provide a comprehensive understanding of the benefits and drawbacks of using digital therapeutics for the management of patients with chronic diseases.

Methods

The scoping review framework developed by Arksey and O'Malley was applied to the process. Using the research method of scope review, the network retrieval of pertinent papers was conducted in eight databases, including PubMed, Web of Science, ScienceDirect, and CNKI. The database was retrieved between the date of database creation and September 20, 2023. The "PCC" principle was used to determine the inclusion criterion. Analyze and discuss the mentioned literature. Findings were presented in tabular and descriptive formats.

Results

The scoping review included 25 studies. The intervention carriers of digital therapeutics included health management systems, digital health platforms, learning machine models, and so on. Professional technologists, medical personnel, and others were among the implementation personnel. Disease management strategies included application-based home workout plan intervention, virtual reality digital control mode intervention, and so on. Digital therapeutics helped patients with symptom monitoring, medication management, weight control, mental health, and everyday activities.

Conclusion

Digital therapeutics improves the treatment of chronic disease patients and promotes health recovery. In the future, under the supervision of the treatment team, we should formulate scientific, standardized, and relevant digital therapeutic disease management programs according to the application status of patients with chronic diseases and develop more customized digital therapeutic projects.