Mindfulness, Chronic Pelvic Pain & Chronic Postoperative Pain

The benefits of mindfulness-based interventions (MBIs) are well-established for psychological and physical health. However, their utility concerning chronic pelvic pain (CPP) and chronic postoperative pain (CPOP) is currently limited. Further, the structure of traditional MBI programmes has been increasingly modified in attempts to improve accessibility and reduce costs; however, there is no consensus regarding how these amendments may affect outcomes. This thesis first reviews current literature focusing on CPP, CPOP, mindfulness-based approaches and applications, models of mindfulness and mechanisms of change. A systematic review of MBIs of non-standard durations for physical health is presented. The findings of this review demonstrated efficacy in several clinical populations, with no significant correlation between intervention duration and magnitude of change evident. Using these findings and the Liverpool Mindfulness Model as a framework, two MBIs were developed for CPP and patients due to undergo hysterectomy surgery and evaluated through randomised controlled studies. Findings are reported on both an intention-to-treat and per-protocol basis and interpreted in terms of statistical and clinical significance. The first study demonstrated that following exposure, CPP patients reported improvements in pain-related outcomes, psychological distress, and subjective well-being. The second study, which is the first known research examining the efficacy of an MBI as a pre-and postoperative rehabilitation tool for hysterectomy patients, demonstrated that preoperatively, MBI exposure protected participants against deteriorating surgical fears and state anxiety. Postoperatively, it was associated with superior pain-related outcomes, higher levels of global quality of recovery and improved psychological distress. Six months post-surgery, reports of new pain problems occurred at a lower frequency in MBI participants, suggesting that participation reduced the incidence of CPOP in this sample. Both studies also explored potential mechanisms of the MBIs thought to underlie positive change. MBI participation was associated with significantly increased dispositional mindfulness, improved emotion regulation and reduced use of maladaptive coping strategies. Research into the role of coping strategies such as distracting and ignoring and into illness perceptions, including personal and treatment control, is also extended. Across both studies, it was evident that low-dose MBIs can elicit beneficial outcomes in these populations; however, an extended duration of participation was associated with a greater magnitude of change. Finally, methodological considerations affecting the interpretation and generalisability of these findings are discussed, as are the original contributions of this programme of research. Recommendations for future research and clinical practice are also offered.