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Chronic Pelvic PainMEMPHISNCT02721108

Mindfulness Meditation for Chronic Pelvic Pain Management

A study testing Mindfulness meditation and Relaxation app in people with Chronic Pelvic Pain, run by Queen Mary University of London at 1 site in United Kingdom.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Chronic pelvic pain (CPP) in women is common, painful and disabling and puts much strain on women's lives and the (National Health Service) NHS. CPP may be related to internal organs, the nervous system or psychological factors and is often difficult to treat. Read more about this study

Who is it for?
Ages 18 years and older, women only
Conditions the study is for
Chronic Pelvic Pain
What is being tested?
Mindfulness meditation and Relaxation app
Could I receive a placebo?
No, everyone receives an active treatment
How many people
90 participants
Where
1 siteUnited Kingdom
Study dates
May 2016to Mar 2017
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • Women only
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Women with diagnosis of organic and non-organic chronic pelvic pain (CPP) for six months or more
  • Age ≥ 18 years
  • Be capable of understanding the information provided, with use of an interpreter if required and being able to understand simple English as is used in the app

Who cannot join

  • Males
  • Absence of diagnosis of organic and non-organic chronic pelvic pain (CPP)
  • Diagnosis of organic and non-organic chronic pelvic pain (CPP) lasting for less than 3 months
  • Age < 18 years
  • No access to a Personal computer or smart phone
  • Unable to speak / understand English
  • Current users of the app content available to the public

Trial locations and contacts

1 site in 1 country.

United Kingdom1 site
  • Barts Health NHS Trust

    London, E1 1BB

Other trials in United Kingdom

About this study

Official title: Mindfulness Meditation Using a Smart-phone Application for Women With Chronic Pelvic Pain

Chronic pelvic pain (CPP) in women is common, painful and disabling and puts much strain on women's lives and the (National Health Service) NHS.

CPP may be related to internal organs, the nervous system or psychological factors and is often difficult to treat. Surgery and drugs have risks and side effects, are expensive and do not help all patients.

Read more

Psychological treatments have potential to improve CPP but are not consistently available. Mindfulness meditation teaches people to accept their sensations and emotions in the present moment. This can help to accept pain better, which enables patients to focus on daily activities and improve their quality of life. It has been shown to help in headache, back pain and depression. Usually mindfulness meditation is taught by attending courses for 8 weeks.

The investigators want to find out in a full-scale trial if mindfulness meditation, taught by using a smartphone app, can help CPP patients.

In preparation for this full-scale study the investigators will conduct the MEMPHIS study to answer the following questions:

  • How many patients are willing to participate?
  • How often they use the app?
  • Reasons for not wanting to participate/not using the app -
  • Which health questionnaires are the most useful ones?
  • How many patients will be required for the full-scale trial?

Patients will receive the usual treatment and be divided into three groups

  • using a 60-day mindfulness meditation app, -- using comparison app with progressive muscle relaxation but no meditation
  • no app

Patients will complete health questionnaires, may be asked to comment in a focus group and record pain, medication changes, surgery and emergency medical visits

Read the detailed description

CPP affects up to 24% women worldwide accounts for 20% of UK gynaecological clinic referrals and has a considerable impact on patients' quality of life and their income. CPP costs the NHS € 3.3bn per year. Despite costly interventions CPP is often resistant to surgical and medical treatment. Multifactorial psychological and somatic causes require a multidimensional approach. Psychological and somatic causes require a multidimensional approach, which is not routinely offered in gynaecology clinics.

Randomized Control Trial (RCT-) evidence suggests that primary inclusion of psychological interventions may be superior to primary surgery. Although psychological treatment is provided across the NHS, mostly in the context of primary care Improving Access to Psychological

Therapies there are problems with capacity, waiting times and overall number of patients being able to access services. Alternatively, patient self-management (PSM) is now recognised as a tool empowering patients to cope better with their condition.

Mindfulness meditation is a potentially valuable PSM tool in CPP.

The investigators conducted a systematic search of literature (07/2013, updated 12/2013) and found no RCTs on mindfulness meditation in CPP. However, two small pilot trials, one in CPP and one in endometriosis patients with promising results.

The investigators decided to undertake a systematic review on the effect of mindfulness meditation and extend the search to other chronic pain conditions (e.g. back pain, headache, fibromyalgia and diabetic neuropathy) because previous systematic reviews had number of limitations, such as not reporting effect size. Two independent reviewers assessed the risk of bias systematically using Review Manager (RevMan) 5.2 software. Out of 472 citations 9 RCTs were finally included. Most studies were of moderate quality; sample sizes were generally small.

Mindfulness meditation had positive effects on depression in chronic pain patients (SMD -0.28; 95%CI -0.53, -0.03; p = 0.03). A trend in reduction of anxiety and affective pain and a trend towards better QUOL, especially the mental health component and better pain acceptance was observed. Only one of the included studies reported the important measure of pain acceptance. If a larger sample size had been available it would have been likely that this and other health outcomes would have shown significant improvements, as was seen in depression (which was studied on n=259 patients), rather than trends. It is the investigators intention to add results to the body of research from a future full-scale trial.

Currently Mindfulness-based treatment is creating lively research interest. Two recent systematic reviews report positive effects on somatisation disorders and psychological stress. Although there is no ongoing study on patients with CPP, other chronic diseases with strong psychological components of depression and anxiety such as COPD and the RFPB-funded pilot study PATHWAYS on Pulmonary Arterial Hypertension are underway.

Of particular interest, due to the similarities in study design to MEMPHIS, is a recently closed pilot study, MIMS (UKCRN ID 13105) that investigated adjustment to multiple sclerosis.

In MIMS meditation teaching was delivered by videoconference. Web-based delivery has also been explored and shown to be feasible for reducing stress, anxiety and depression; both options are lacking the flexibility of a smartphone app, which is being proposed. There is evolving work on care pathways through primary secondary and tertiary levels for patients with CPP and recently mindfulness meditation has been introduced in Dorset, albeit delivered face-to-face. This could be replaced by cheaper and more flexible app-delivered meditation training.

This study will address the knowledge gaps and provide by:

  1. Providing feasibility data for a large multicentre RCT aimed at rigorously testing Mindfulness meditation in CPP
  2. Establishing whether this app could be seamlessly integrated into CPP pathways
Being tested
Mindfulness meditation, Relaxation app
Keywords
Mindfulness, Headspace, Psychological approaches, Progressive muscle relaxation

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Mindfulness meditationBehavioural

    The meditation content is a structured and progressive course, layering in new techniques and concepts over successive sessions. The course was created and narrated by a former monk - Andy Puddicombe - drawing on a secularised version of the techniques he was taught over 10 years' experience in monasteries around the world. The first 30 days cover basic techniques, assuming no previous experience of meditation. The second 30 days focus specifically on the use of these techniques with respect to pain. The duration of individual sessions builds over time. Days 1-10 are 10 minutes in duration, days 11-20 are 15 minutes in duration, and days 21-60 are 20 minutes in duration.

  • Relaxation appBehavioural

    The Active Control group will use the same app, but the app will be configured so that they will hear a series of non-meditative progressive muscle relaxation instructions, also narrated by Andy Puddicombe. These sessions will be identical every day, except that their duration will increase to mirror the increasing duration of the meditation content being listened to by the Intervention group.

Study groups in NCT02721108
Study groupRoleWhat they receive
Mindfulness: Group AExperimentalUsing a 60-day mindfulness instruction meditation app: 60 days of 10 and 20 minute long app modules with a spoken guide to mindfulness meditation, to be used once a day, including modules on the basics of mindfulness and a module targeted to pain, which can re-revisited until the end of the study
Receives: Behavioral: Mindfulness meditation
Relaxation: Group BActive comparatorUsing comparison relaxation app with a series of non-meditative progressive muscle relaxation instructions: 60 days of 10 and 20 minute long app modules to be used once per day with spoken words and relaxing sounds, which can re-revisited until the end of the study
Receives: Behavioral: Relaxation app
Treatment as usual: Group CNo interventionNo app: treatment as usual (watch and wait, medication and/or surgery) to investigate if any app intervention makes a difference to wellbeing and to ascertain dropout rates for the full-scale trial in patients who perceive that they are getting no intervention.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Duration of recruitment

    Length of time it will take to recruit 90 participant from the time recruitment starts

    Measured: 6 months

  2. Patient adherence to app use

    Measured: first 8 weeks post-randomisation

Secondary outcomes (12)
  1. Quality of life score-Physical Functioning subscale (as measured by the RAND Short form Health Survey (SF-36)

    Measured: at 60 days, 3 months, and 6 months post-randomisation

  2. Quality of life score-Social Functioning subscale (as measured by the RAND Short form Health Survey (SF-36)

    Measured: at 60 days, 3 months, and 6 months post-randomisation

  3. Quality of life score-Pain subscale (as measured by the RAND Short form Health Survey (SF-36)

    Measured: at 60 days, 3 months, and 6 months post-randomisation

  4. Quality of life score-General Health subscale (as measured by the RAND Short form Health Survey (SF-36)

    Measured: at 60 days, 3 months, and 6 months post-randomisation

  5. Depression score as measured by the Hospital Anxiety and Depression Scale (HADS)

    Measured: at 60 days, 3 months, and 6 months post-randomisation

  6. Anxiety score (as measured by HADS)

    Measured: at 60 days, 3 months, and 6 months post-randomisation

  7. Mindfulness score as measure by the Cognitive and Mindfulness - Revised (CAMS - R) scale

    Measured: at 60 days, 3 months, and 6 months post-randomisation

  8. Pain related disability score (as measured by the Chronic Pain Grade (CPG) disability subscale

    Measured: at 60 days, 3 months, and 6 months post-randomisation

  9. Self efficacy score (as measured by the Pain Self-Efficacy Questionnaire (PSEQ)

    Measured: at 60 days, 3 months, and 6 months post-randomisation

  10. Pain acceptance score (as measured Chronic Pain Acceptance Questionnaire (CPAQ-8)

    Measured: at 60 days, 3 months, and 6 months post-randomisation

  11. Sexual Health Outcomes score (as measured by Sexual Health Outcomes in Women Questionnaire (SHOW-Q)

    Measured: at 60 days, 3 months, and 6 months post-randomisation

  12. Subjective outcome score (as measured by Measure Yourself Medical Outcome Profile (MYMOP)

    Measured: at 60 days, 3 months, and 6 months post-randomisation

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted28 Mar 2016 (estimated)
  2. Study startMay 2016
  3. Primary completionMar 2017
  4. Study completionMar 2017

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Supportive care
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
90 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02721108
Sponsor's protocol ID
010817QM
Other IDs
10925965
Acronym
MEMPHIS
Status last verified
Jun 2016
First submitted
28 Sep 2015
Last updated
20 Sep 2017
Results posted
No
Data monitoring committee
No
Individual data sharing
Undecided: This is a feasibility study. data will be used to inform design of a full-scale trial.

Publications

  • Forbes G, Newton S, Cantalapiedra Calvete C, Birch J, Dodds J, Steed L, Rivas C, Khan K, Rohricht F, Taylor S, Kahan BC, Ball E. MEMPHIS: a smartphone app using psychological approaches for women with chronic pelvic pain presenting to gynaecology clinics: a randomised feasibility trial. BMJ Open. 2020 Mar 12;10(3):e030164. doi: 10.1136/bmjopen-2019-030164.

    PubMed 32165549
  • Ball E, Newton S, Kahan BC, Forbes G, Wright N, Cantalapiedra Calvete C, Gibson HAL, Rogozinska E, Rivas C, Taylor SJC, Birch J, Dodds J. Smartphone App Using Mindfulness Meditation for Women With Chronic Pelvic Pain (MEMPHIS): Protocol for a Randomized Feasibility Trial. JMIR Res Protoc. 2018 Jan 15;7(1):e8. doi: 10.2196/resprot.7720.

    PubMed 29335232

Questions about this trial

What is this clinical trial studying?

A study testing Mindfulness meditation and Relaxation app in people with Chronic Pelvic Pain, run by Queen Mary University of London at 1 site in United Kingdom.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 20 Sep 2017. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Duration of recruitment (time frame: 6 months). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02721108, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 20 Sep 2017.

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