Daily Interaction Between Meditation and Endometriosis Pain and the Mindfulness Effect on Pain Interference in Activities Throughout a Brief Mindfulness-Based Intervention

Objectives Previous studies have examined simplified unidirectional associations between mindfulness, pain, and its functional interference, overlooking individual variations and complex interactions. The present study aimed to address this limitation by investigating the reciprocal lagged effects of mindfulness meditation and endometriosis-related pain while evaluating the impact of a brief mindfulness-based intervention (bMBI) on pain interference with activities (PI).

Exploratory analyses were conducted of a pilot randomized controlled trial (n = 63). A random intercept cross-lagged panel model was used to assess the reciprocal influence between the minutes of meditation and pain intensity. Effects of the bMBI on PI were evaluated using a latent growth curve model. Analyses were performed over the initial, middle, and last 5 days of the bMBI.

Minutes of meditation practice were positively associated with pain intensity during the initial period. Increased meditation practice above the average in the middle intervention days led women to perceive more pain, which produced a reduction in meditation practice. This pattern was reversed in the last intervention period, where the increase in the average meditation practice reduced pain. Also, the increase in pain motivated an increase in meditation in one cross-lag. However, the bMBI was unable to improve PI.

Women suffering from endometriosis-related pain show a bMBI trajectory involving predominant increased pain perception and associated meditation and activities avoidance in the early learning stage. Mindfulness skills became more effective in dealing with endometriosis pain and related meditation avoidance from the fourth week. The absence of improvement in PI indicates the necessity of alternative strategies to achieve this outcome. Preregistration Brazilian Registry of Clinical Trials U1111-1233–4802. Similar content being viewed by others Data Availability Data are available at https://doi.org/10.5281/zenodo.8247842.

Burney, R. O., & Giudice, L. C. (2012). Pathogenesis and pathophysiology of endometriosis. Fertility and Sterility, 98(3), 511–519. https://doi.org/10.1016/j.fertnstert.2012.06.029 Burns, J. W., Jensen, M. P., Gerhart, J., Thorn, B. E., Lillis, T. A., Carmody, J., & Keefe, F. (2023). Cognitive therapy, mindfulness-based stress reduction, and behavior therapy for people with chronic low back pain: A comparative mechanisms study. Journal of Consulting and Clinical Psychology, 91(3), 171–187. https://doi.org/10.1037/ccp0000801 Cashin, A. G., Lee, H., Traeger, A. C., Moseley, G. L., Hübscher, M., Kamper, S. J., Skinner, I. W., & McAuley, J. H. (2022). Producing clinically meaningful reductions in disability: A causal mediation analysis of a patient education intervention. The Journal of Pain, 23(2), 236–247. https://doi.org/10.1016/j.jpain.2021.07.007 Chen, Y., Wang, H., Wang, S., Shi, X., Wang, Q., & Ren, Q. (2019). Efficacy of ten interventions for endometriosis: A network meta-analysis. Journal of Cellular Biochemistry, 120(8), 13076–13084. https://doi.org/10.1002/jcb.28579 Chisari, C., & Chilcot, J. (2017). The experience of pain severity and pain interference in vulvodynia patients: The role of cognitive-behavioural factors, psychological distress and fatigue. Journal of Psychosomatic Research, 93, 83–89. https://doi.org/10.1016/j.jpsychores.2016.12.010 Crombez, G., Eccleston, C., Van den Broeck, A., Goubert, L., & Van Houdenhove, B. (2004). Hypervigilance to pain in fibromyalgia: The mediating role of pain intensity and catastrophic thinking about pain. The Clinical Journal of Pain, 20(2), 98–102. https://doi.org/10.1097/00002508-200403000-00006 Curtin, K. B., & Norris, D. (2017). The relationship between chronic musculoskeletal pain, anxiety and mindfulness: Adjustments to the fear-avoidance model of chronic pain. Scandinavian Journal of Pain, 17, 156–166. https://doi.org/10.1016/j.sjpain.2017.08.006 Davis, M. C., Zautra, A. J., Wolf, L. D., Tennen, H., & Yeung, E. W. (2015). Mindfulness and cognitive-behavioral interventions for chronic pain: Differential effects on daily pain reactivity and stress reactivity. Journal of Consulting and Clinical Psychology, 83(1), 24–35. https://doi.org/10.1037/a0038200 Davydov, D. M., Galvez-Sánchez, C. M., Montoro, C. I., de Guevara, C. M. L., & Reyes del Paso, G. A. (2021). Personalized behavior management as a replacement for medications for pain control and mood regulation. Scientific Reports, 11, 20297. https://doi.org/10.1038/s41598-021-99803-x Day, M. A. (2017). Mindfulness-based cognitive therapy for chronic pain: A clinical manual and guide. Wiley. Day, M. A., & Thorn, B. E. (2016). The mediating role of pain acceptance during mindfulness-based cognitive therapy for headache. Complementary Therapies in Medicine, 25, 51–54. https://doi.org/10.1016/j.ctim.2016.01.002 de França Moreira, M., Gamboa, O. L., & Pinho Oliveira, M. A. (2022). A single-blind, randomized, pilot study of a brief mindfulness-based intervention for the endometriosis-related pain management. European Journal of Pain, 26(5), 1147–1162. https://doi.org/10.1002/ejp.1939 de França Moreira, M., Gamboa, O. L., & Pinho Oliveira, M. A. (2023). Cognitive-affective changes mediate the mindfulness-based intervention effect on endometriosis-related pain and mental health: A path analysis approach. European Journal of Pain, 27(10), 1187–1202. https://doi.org/10.1002/ejp.2149 de Vibe, M., Solhaug, I., Rosenvinge, J. H., Tyssen, R., Hanley, A., & Garland, E. (2018). Six-year positive effects of a mindfulness-based intervention on mindfulness, coping and well-being in medical and psychology students; results from a randomized controlled trial. PLoS ONE, 13(4), e0196053. https://doi.org/10.1371/journal.pone.0196053 Delucchi, K. L., & Bostrom, A. (2004). Methods for analysis of skewed data distributions in psychiatric clinical studies: Working with many zero values. The American Journal of Psychiatry, 161(7), 1159–1168. https://doi.org/10.1176/appi.ajp.161.7.1159 Diotaiuti, P., Corrado, S., Mancone, S., Falese, L., Rodio, A., Siqueira, T. C., & Andrade, A. (2021). Influence of cognitive orientation and attentional focus on pain perception. International Journal of Environmental Research and Public Health, 18(13), 7176. https://doi.org/10.3390/ijerph18137176 Facchin, F., Barbara, G., Saita, E., Mosconi, P., Roberto, A., Fedele, L., & Vercellini, P. (2015). Impact of endometriosis on quality of life and mental health: Pelvic pain makes the difference. Journal of Psychosomatic Obstetrics & Gynecology, 36(4), 135–141. https://doi.org/10.3109/0167482X.2015.1074173 Falkenström, F., Solomonov, N., & Rubel, J. A. (2022). How to model and interpret cross-lagged effects in psychotherapy mechanisms of change research: A comparison of multilevel and structural equation models. Journal of Consulting and Clinical Psychology, 90(5), 446–458. https://doi.org/10.1037/ccp0000727 Garland, E. L., & Howard, M. O. (2013). Mindfulness-oriented recovery enhancement reduces pain attentional bias in chronic pain patients. Psychotherapy and Psychosomatics, 82(5), 311–318. https://doi.org/10.1159/000348868 Hamaker, E. L., Kuiper, R. M., & Grasman, R. P. P. P. (2015). A critique of the cross-lagged panel model. Psychological Methods, 20(1), 102–116. https://doi.org/10.1037/a0038889 Hayes, S. C., Strosahl, K., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., Polusny, M. A., Dykstra, T. A., Batten, S. V., Bergan, J., Stewart, S. H., Zvolensky, M. J., Eifert, G. H., Bond, F. W., Forsyth, J. P., Karekla, M., & McCurry, S. M. (2004). Measuring experiential avoidance: A preliminary test of a working model. The Psychological Record, 54(4), 553–578. https://doi.org/10.1007/BF03395492 Jay, K., Brandt, M., Jakobsen, M. D., Sundstrup, E., Berthelsen, K. G., Schraefel, M., Sjøgaard, G., & Andersen, L. L. (2016). Ten weeks of physical-cognitive-mindfulness training reduces fear-avoidance beliefs about work-related activity: Randomized controlled trial. Medicine, 95(34), e3945. https://doi.org/10.1097/MD.0000000000003945 Jensen, M. P., Ehde, D. M., & Day, M. A. (2016). The behavioral activation and inhibition systems: Implications for understanding and treating chronic pain. The Journal of Pain: Official Journal of the American Pain Society, 17(5), 529.e1-e529.e18. https://doi.org/10.1016/j.jpain.2016.02.001 Johannsen, M., O’Toole, M. S., O’Connor, M., Jensen, A. B., & Zachariae, R. (2017). Clinical and psychological moderators of the effect of mindfulness-based cognitive therapy on persistent pain in women treated for primary breast cancer - Explorative analyses from a randomized controlled trial. Acta Oncologica, 56(2), 321–328. https://doi.org/10.1080/0284186X.2016.1268713 Kabat-Zinn, J. (2013). Full catastrophe living (revised edition): Using the wisdom of your body and mind to face stress, pain, and illness. Random House Publishing Group. Kabat-Zinn, J., Lipworth, L., & Burney, R. (1985). The clinical use of mindfulness meditation for the self-regulation of chronic pain. Journal of Behavioral Medicine, 8(2), 163–190. https://doi.org/10.1007/BF00845519 Kerr, C. E., Sacchet, M. D., Lazar, S. W., Moore, C. I., & Jones, S. R. (2013). Mindfulness starts with the body: Somatosensory attention and top-down modulation of cortical alpha rhythms in mindfulness meditation. Frontiers in Human Neuroscience, 7, 12. https://doi.org/10.3389/fnhum.2013.00012 Khoo, E.-L., Small, R., Cheng, W., Hatchard, T., Glynn, B., Rice, D. B., Skidmore, B., Kenny, S., Hutton, B., & Poulin, P. A. (2019). Comparative evaluation of group-based mindfulness-based stress reduction and cognitive behavioural therapy for the treatment and management of chronic pain: A systematic review and network meta-analysis. Evidence-Based Mental Health, 22(1), 26–35. https://doi.org/10.1136/ebmental-2018-300062 Kim, D., Woo, C.-W., & Kim, S.-G. (2022). Neural mechanisms of pain relief through paying attention to painful stimuli. Pain, 163(6), 1130–1138. https://doi.org/10.1097/j.pain.0000000000002464 Koninckx, P. R., Ussia, A., Adamyan, L., Wattiez, A., & Donnez, J. (2012). Deep endometriosis: Definition, diagnosis, and treatment. Fertility and Sterility, 98(3), 564–571. https://doi.org/10.1016/j.fertnstert.2012.07.1061 Lauche, R., Cramer, H., Dobos, G., Langhorst, J., & Schmidt, S. (2013). A systematic review and meta-analysis of mindfulness-based stress reduction for the fibromyalgia syndrome. Journal of Psychosomatic Research, 75(6), 500–510. https://doi.org/10.1016/j.jpsychores.2013.10.010 Leuenberger, J., Kohl Schwartz, A. S., Geraedts, K., Haeberlin, F., Eberhard, M., von Orellie, S., Imesch, P., & Leeners, B. (2022). Living with endometriosis: Comorbid pain disorders, characteristics of pain and relevance for daily life. European Journal of Pain, 26(5), 1021–1038. https://doi.org/10.1002/ejp.1926 Lindsay, E. K., & Creswell, J. D. (2017). Mechanisms of mindfulness training: Monitor and acceptance theory (MAT). Clinical Psychology Review, 51, 48–59. https://doi.org/10.1016/j.cpr.2016.10.011 Madden, V. J., Bellan, V., Russek, L. N., Camfferman, D., Vlaeyen, J. W. S., & Moseley, G. L. (2016). Pain by association? Experimental modulation of human pain thresholds using classical conditioning. The Journal of Pain, 17(10), 1105–1115. https://doi.org/10.1016/j.jpain.2016.06.012 McClintock, A. S., McCarrick, S. M., Garland, E. L., Zeidan, F., & Zgierska, A. E. (2019). Brief mindfulness-based interventions for acute and chronic pain: A systematic review. Journal of Alternative and Complementary Medicine, 25(3), 265–278. https://doi.org/10.1089/acm.2018.0351 McCracken, L. M., & Keogh, E. (2009). Acceptance, mindfulness, and values-based action may counteract fear and avoidance of emotions in chronic pain: An analysis of anxiety sensitivity. The Journal of Pain, 10(4), 408–415. https://doi.org/10.1016/j.jpain.2008.09.015 McWilliams, L. A., & Asmundson, G. J. G. (2007). The relationship of adult attachment dimensions to pain-related fear, hypervigilance, and catastrophizing. Pain, 127(1–2), 27–34. https://doi.org/10.1016/j.pain.2006.07.020 Meehan, E., & Carter, B. (2020). Moving with pain: What principles from somatic practices can offer to people living with chronic pain. Frontiers in Psychology, 11, 620381. https://doi.org/10.3389/fpsyg.2020.620381 Moreira, M. F., Gamboa, O. L., & Pinho Oliveira, M. A. (2022). A single-blind, randomized, pilot study of a brief mindfulnessbased intervention for the endometriosis-related pain management. European Journal of Pain , 26(5), 1147–1162. https://doi.org/10.1002/ejp.1939 Moreira, M. F., Gamboa, O. L., & Oliveira, M. A. P. (2023). Mindfulness-based intervention effect on the psychophysiological marker of self-regulation in women with endometriosis-related chronic pain. The Journal of Pain, 25(1), 118–131. https://doi.org/10.1016/j.jpain.2023.07.026 Mörtberg, E., Hoffart, A., Boecking, B., & Clark, D. M. (2015). Shifting the focus of one’s attention mediates improvement in cognitive therapy for social anxiety disorder. Behavioural and Cognitive Psychotherapy, 43(1), 63–73. https://doi.org/10.1017/S1352465813000738 Mulder, J. D., & Hamaker, E. L. (2021). Three extensions of the random intercept cross-lagged panel model. Structural Equation Modeling, 28(4), 638–648. https://doi.org/10.1080/10705511.2020.1784738 Nathan, H. J., Poulin, P., Wozny, D., Taljaard, M., Smyth, C., Gilron, I., Sorisky, A., Lochnan, H., & Shergill, Y. (2017). Randomized trial of the effect of mindfulness-based stress reduction on pain-related disability, pain intensity, health-related quality of life, and A1C in patients with painful diabetic peripheral neuropathy. Clinical Diabetes, 35(5), 294–304. https://doi.org/10.2337/cd17-0077 Nicolardi, V., Simione, L., Scaringi, D., Malinowski, P., Yordanova, J., Kolev, V., Mauro, F., Giommi, F., Barendregt, H. P., Aglioti, S. M., & Raffone, A. (2024). The two arrows of pain: Mechanisms of pain related to meditation and mental states of aversion and identification. Mindfulness, 15(4), 753–774. https://doi.org/10.1007/s12671-021-01797-0 Nigol, S. H., & Di Benedetto, M. (2020). The relationship between mindfulness facets, depression, pain severity and pain interference. Psychology, Health & Medicine, 25(1), 53–63. https://doi.org/10.1080/13548506.2019.1619786 Pardos-Gascón, E. M., Narambuena, L., Leal-Costa, C., & van-der Hofstadt-Román, C. J. (2021). Differential efficacy between cognitive-behavioral therapy and mindfulness-based therapies for chronic pain: Systematic review. International Journal of Clinical and Health Psychology: IJCHP, 21(1), 100197. https://doi.org/10.1016/j.ijchp.2020.08.001 Pérez-Fernández, J. I., Salaberria, K., & Ruiz de Ocenda, Á. (2022). Mindfulness-based pain management (MBPM) for chronic pain: A randomized clinical trial. Mindfulness, 13(12), 3153–3165. https://doi.org/10.1007/s12671-022-02023-1 Petrova, K., Nevarez, M. D., Waldinger, R. J., Preacher, K. J., & Schulz, M. S. (2021). Self-distancing and avoidance mediate the links between trait mindfulness and responses to emotional challenges. Mindfulness, 12(4), 947–958. https://doi.org/10.1007/s12671-020-01559-4 Ranjbar, S., Mazidi, M., Sharpe, L., Dehghani, M., & Khatibi, A. (2020). Attentional control moderates the relationship between pain catastrophizing and selective attention to pain faces on the antisaccade task. Scientific Reports, 10(1), 12885. https://doi.org/10.1038/s41598-020-69910-2 Rischer, K. M., González-Roldán, A. M., Montoya, P., Gigl, S., Anton, F., & van der Meulen, M. (2020). Distraction from pain: The role of selective attention and pain catastrophizing. European Journal of Pain, 24(10), 1880–1891. https://doi.org/10.1002/ejp.1634 Rosseel, Y. (2012). Lavaan: An R package for structural equation modeling and more. Version 0.5--12 (BETA). Journal of Statistical Software, 48(2), 1–36. https://users.ugent.be/~yrosseel/lavaan/lavaanIntroduction.pdf Russell, T. A., & Arcuri, S. M. (2015). A neurophysiological and neuropsychological consideration of mindful movement: Clinical and research implications. Frontiers in Human Neuroscience, 9, 282. https://doi.org/10.3389/fnhum.2015.00282 Sánchez-Rodríguez, E., Racine, M., Castarlenas, E., Tomé-Pires, C., Galán, S., Jensen, M. P., & Miró, J. (2021). Behavioral activation and inhibition systems: Further evaluation of a BIS-BAS model of chronic pain. Pain Medicine, 22(4), 848–860. https://doi.org/10.1093/pm/pnaa330 Schütze, R., Rees, C., Preece, M., & Schütze, M. (2010). Low mindfulness predicts pain catastrophizing in a fear-avoidance model of chronic pain. Pain, 148(1), 120–127. https://doi.org/10.1016/j.pain.2009.10.030 Seng, E. K., Singer, A. B., Metts, C., Grinberg, A. S., Patel, Z. S., Marzouk, M., Rosenberg, L., Day, M., Minen, M. T., Lipton, R. B., & Buse, D. C. (2019). Does mindfulness-based cognitive therapy for migraine reduce migraine-related disability in people with episodic and chronic migraine? A phase 2b pilot randomized clinical trial. Headache, 59(9), 1448–1467. https://doi.org/10.1111/head.13657 Slepian, P. M., Ankawi, B., & France, C. R. (2020). Longitudinal analysis supports a fear-avoidance model that incorporates pain resilience alongside pain catastrophizing. Annals of Behavioral Medicine, 54(5), 335–345. https://doi.org/10.1093/abm/kaz051 Steiger, J. H. (2007). Understanding the limitations of global fit assessment in structural equation modeling. Personality and Individual Differences, 42(5), 893–898. https://doi.org/10.1016/j.paid.2006.09.017 Turner, J. A., Anderson, M. L., Balderson, B. H., Cook, A. J., Sherman, K. J., & Cherkin, D. C. (2016). Mindfulness-based stress reduction and cognitive behavioral therapy for chronic low back pain: Similar effects on mindfulness, catastrophizing, self-efficacy, and acceptance in a randomized controlled trial. Pain, 157(11), 2434–2444. https://doi.org/10.1097/j.pain.0000000000000635 Usami, S. (2021). On the differences between general cross-lagged panel model and random-intercept cross-lagged panel model: Interpretation of cross-lagged parameters and model choice. Structural Equation Modeling, 28(3), 331–344. https://doi.org/10.1080/10705511.2020.1821690 Van Damme, S. (2010). A self-regulation perspective on pain and disability: Is there a role for executive functions? In PsycEXTRA dataset. https://doi.org/10.1037/e524372011-093 Vlaeyen, J. W. S., & Linton, S. J. (2012). Fear-avoidance model of chronic musculoskeletal pain: 12 years on. Pain, 153(6), 1144–1147. https://doi.org/10.1016/j.pain.2011.12.009 Wilson, J. M., Haliwa, I., Lee, J., & Shook, N. J. (2023). The role of dispositional mindfulness in the fear-avoidance model of pain. PLoS ONE, 18(1), e0280740. https://doi.org/10.1371/journal.pone.0280740 Zheng, X., & Yang, J. S. (2018). Latent growth curve analysis with categorical data: Model specification, estimation, and panel attrition. Multivariate Behavioral Research, 53(1), 134–135. https://doi.org/10.1080/00273171.2017.1404898 Zorn, J., Abdoun, O., Bouet, R., & Lutz, A. (2020). Mindfulness meditation is related to sensory-affective uncoupling of pain in trained novice and expert practitioners. European Journal of Pain, 24(7), 1301–1313. https://doi.org/10.1002/ejp.1576 Zorn, J., Abdoun, O., Sonié, S., & Lutz, A. (2021). Cognitive defusion is a core cognitive mechanism for the sensory-affective uncoupling of pain during mindfulness meditation. Psychosomatic Medicine, 83(6), 566–578. https://doi.org/10.1097/PSY.0000000000000938 Author information Authors and Affiliations Contributions We state that all listed authors contributed to the preparation of the manuscript as follows: Marcelo de França Moreira: conceptualization, investigation, methodology, formal analysis, writing—original draft preparation, supervision. Olga Lucia Gamboa: conceptualization, writing—original draft preparation, supervision. Marco Aurelio Pinho Oliveira: conceptualization, methodology, writing—original draft preparation, supervision. All authors discussed the results and commented on the manuscript. Corresponding author Ethics declarations Ethics Statement This study was approved for human participants by the Rio de Janeiro State University Ethics Committee. Informed Consent All participants gave their informed written consent before participating in the study. Conflict of Interest The authors declare no competing interests. Use of Artificial Intelligence Statement AI was not used in the writing of this manuscript. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary Information Below is the link to the electronic supplementary material. 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