513: Exploring Predictors of Response to an Online Pain Management Program for Endometriosis

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary visceral / pelvic pain, Psychology, Pain in Special Populations , Treatment/management

Background and Aims: Chronic pelvic pain is the most concerning symptom of endometriosis and is associated with high rates of pain disability, depression, and anxiety [1]. Emerging research indicates the potential of psychological interventions in improving pain disability and psychological distress in endometriosis [2, 3]. Our randomized controlled trial (N = 193) of an online psychological pain management program for endometriosis demonstrated a ≥50% symptom improvement in pain disability, depression, and anxiety in the treatment group relative to control [4]. An important area for further research is to understand the characteristics of patients likely to benefit from such programs to guide their optimal use.

Methods: The current study was a secondary analysis of data from our previous randomized controlled trial (N = 193) and examined the relationships between commonly collected demographic and clinical data, baseline symptoms, and psychological variables with major clinical response (defined as ≥50% symptom improvement), treatment completion, and treatment satisfaction. Major clinical response in pain disability, depression, anxiety, and average pain intensity was examined at post-treatment and 3-month follow-up. Multivariate binary logistic regression analyses assessed the unique contribution of each predictor variable in the likelihood of major clinical response, treatment completion, and treatment satisfaction.

Results: Overall, few predictors were significant across ≥1 clinical outcome, none were significant across all 4 clinical outcomes, and no predictors of treatment completion or satisfaction emerged. However, a key finding was that higher baseline scores were uniquely associated with increased odds of major clinical response on all 4 outcomes at both timepoints.

Conclusions: Consistent with the wider pain management literature, no consistent or robust predictors of major clinical response, treatment completion, or treatment satisfaction emerged from the analyses [5, 6, 7, 8]. However, a key finding was each of the 4 clinical outcomes (i.e., pain disability, depression, anxiety, and pain intensity) were uniquely predicted by their respective baseline scores. Based on the examined predictors, it appears that online psychological pain management programs may be suitable for a range of patients with endometriosis-related pain. However, further research is needed to replicate the current findings and examine other potential predictors and programs in this patient population.

References: [1] Van Barneveld E, Manders J, Van Osch FHM, Van Poll M, Visser L, Van Hanegem N, Lim AC, Bongers MY, Leue C. Depression, Anxiety, and Correlating Factors in Endometriosis: A Systematic Review and Meta-Analysis. J Womens Health 2022;31:219–230.
[2] Hansen KE, Brandsborg B, Kesmodel US, Forman A, Kold M, Pristed R, Donchulyesko O, Hartwell D, Vase L. Psychological interventions improve quality of life despite persistent pain in endometriosis: results of a 3-armed randomized controlled trial. Quality of Life Research 2023;32:1727–1744.
[3] Van Niekerk L, Weaver-Pirie B, Matthewson M. Psychological interventions for endometriosis-related symptoms: a systematic review with narrative data synthesis. Arch Womens Ment Health 2019;22:723–735.
[4] Chandra SS, Bisby MA, Scott AJ, Titov N, Dear BF. The endometriosis pain course: a randomized controlled trial of an internet-delivered psychological pain management program for endometriosis. Pain 2026;167:80-93.
[5] Dear BF, Gandy M, Karin E, Ricciardi T, Langman N, Staples LG, Fogliati VJ, Sharpe L, Mclellan LF, Titov N. The Pain Course: Exploring predictors of clinical response to an Internet-delivered pain management program. Pain 2016;157:2257–2268.
[6] Gilpin HR, Keyes A, Stahl DR, Greig R, McCracken LM. Predictors of Treatment Outcome in Contextual Cognitive and Behavioral Therapies for Chronic Pain: A Systematic Review. Journal of Pain 2017;18:1153–1164.
[7] Dear BF, Walker J, Karin E, Asrianti L, England J, Feliciano I, Bisby MA, Nielssen O, Kayrouz R, Cross S, Staples LG, Hadjistavropoulos HD, Titov N. Evaluation of a therapist-guided virtual psychological pain management program when provided as routine care: a prospective pragmatic cohort study. Pain Medicine (United States) 2023;24:1372–1385.
[8] Scott, A. J., Walker, J., Karin, E., Gandy, M., Dudeney, J., Heriseanu, A. I., Bisby, M. A., Sharpe, L., Ali, S., Titov, N., & Dear, B. F. Exploring predictors of clinical response to a transdiagnostic, internet-delivered psychological intervention for people with chronic health conditions. Health Psychology 2025;44:653–663.

Presenting Author: Dr Shianika Chandra
Submitting Author: Shianika Chandra

Senior Author: Prof Blake F Dear

IASP 2026 Global Year theme of Neuropathic Pain: No

• Dr Shianika S Chandra: PhD - Macquarie University
• Dr Amelia J Scott: PhD - Macquarie University
• Dr Madelyne A Bisby: PhD - Macquarie University
• Prof Nickolai Titov: PhD - Macquarie University
• Prof Blake F Dear: PhD - Macquarie University