A Randomized Trial of a Remotely Delivered Group Pelvic Yoga Program for Women with Chronic Pelvic Pain Syndrome
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PROJECT SUMMARY One out of seven women suffer from chronic pelvic pain, a syndrome leading to depression, social isolation, sexual dysfunction, physical inactivity, and progressive pain-related disability. Unfortunately, few clinical treatments for chronic pelvic pain are supported by rigorous evidence of efficacy, and most have limitations that decrease their safety or accessibility for many women in the community. Women with chronic pelvic pain also have high rates of exposure to sexual and interpersonal trauma, which can complicate their engagement with clinical treatments. As a result, many women are anxious to identify alternate management strategies for pelvic pain that are not only effective but better tolerated, more patient-centered, and more accessible. Yoga is a set of complementary physical and mental practices with the potential to improve pelvic pain in women through multiple mechanisms. When practiced in a way that emphasizes careful practice of yoga postures, mindful awareness of body structures (such as the pelvic floor), deep breathing and relaxation techniques, and trauma-informed care principles, yoga can be used to help women improve pelvic floor dysfunction, correct maladaptive postural and physical behaviors, decrease comorbid anxiety and perceived stress, and overcome deconditioning associated with chronic pain. Furthermore, yoga as a complementary treatment modality does not require intensive supervision by clinician specialists or repeated visits to healthcare facilities. With the rise of videoconference-based yoga instruction, women do not even need to travel back and forth to brick-and mortar yoga studios, but instead gain access to specialized yoga instruction, maintain regular yoga practice, and interact with others with the same indication from their own homes. To evaluate the feasibility of pelvic yoga as a complementary management strategy for women with chronic pelvic pain, our team collaborated with an expert yoga panel to develop and refine a structured pelvic yoga program grounded in a biophysiological model of female chronic pelvic pain. In a randomized feasibility trial, women with chronic pelvic pain recruited from multiple locations in California were randomly assigned to a study yoga program consisting of twice-weekly group classes conducted by videoconference supplemented by once weekly individual practice, or a control program of time-equivalent group instruction and individual practice of non-specific muscle stretching and strengthening exercises. Following the successful completion of this pilot, we now propose to conduct a full-scale, fully remote trial in women recruited nationally, to rigorously evaluate the efficacy of remotely delivered pelvic yoga and to explore potential mediators of treatment benefit. This research is designed to provide rigorous evidence of the efficacy and safety of a remotely delivered pelvic yoga program as a potentially patient-centered, scalable, community-based self-management strategy for chronic pelvic pain, as one of the most burdensome, complex, and common pain syndromes in women.
