Vulvar Pain Symptom Improvement and Changes in Resting-State Brain Functional Connectivity Following Mindfulness-Based Stress Reduction for Provoked Vestibulodynia: A Single-Arm Pre-Post Pilot Study - Abstract
Background: Mindfulness-based stress reduction (MBSR) has been shown to improve symptoms in women with provoked vestibulodynia (PVD); however, the mechanism underlying symptom improvement with MBSR remains unknown. Aim: To investigate the effects of an 8-week MBSR group treatment on PVD symptoms and brain functional connectivity. Method: In this single-arm pilot study, changes in symptoms were assessed in two groups of women with PVD (n1 =9, n2 =12) who completed an 8-week MBSR group treatment. Resting-state brain imaging was performed pre- and post-MBSR in a subsample of the second group (n=10). Post-treatment effect size changes in symptoms and brain functional connectivity were estimated. Outcomes: Change in resting state brain connectivity, cognition, vulvar pain and vaginal muscle tenderness, and mood after MBSR Results: Participants reported reduced vulvar pain, improved mood, decreased rumination, and enhanced mindfulness skills after MBSR group treatment. Changes in functional brain connectivity were observed primarily in default mode and salience/ventral attention networks. Many of these brain connectivity changes were associated with improvements in pain, mindfulness, mood, and rumination. Clinical Implications: The study provides support for the hypothesis that mindfulness training can improve clinical features of PVD via impact on the brain’s functional connectivity. Strengths and Limitations: This pilot study identified brain targets and provided empirical estimates for effect sizes related to changes in symptoms and brain connectivity in women with PVD. However, these findings must be interpreted with caution given the small sample size. Conclusion: The findings from this pilot study provide preliminary support for the hypotheses that 8-week MBSR group treatment results in brain functional connectivity changes associated with clinically relevant improvements in pain symptoms as well as positive shifts in measures of mood and rumination.