Aliment Pharmacol Ther. 2023 Apr;57(8):861-871.doi: 10.1111/apt.17399. Epub 2023 Feb 2.

Shirley Regev ¹, Doron Schwartz ², Orly Sarid ¹, Ganit Goren ¹, Vered Slonim-Nevo ¹, Michael Friger ³, Ruslan Sergienko ³, Dan Greenberg ⁴, Alon Monsonego ⁵, Anna Nemirovsky ⁵, Shmuel Odes ⁶

Author information

¹Department of Social Work, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

²Department of Gastroenterology and Hepatology, Soroka Medical Center, Beer-Sheva, Israel.

³Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

⁴Department of Health Systems Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

⁵Department of Microbiology, Immunology and Genetics, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

⁶Division of Clinical Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

Abstract

Background: Chronic abdominal pain and fatigue are characteristics of Crohn's disease (CD) and contribute to functional impairments.

Aims: To examine whether CD-tailored cognitive-behavioural and mindfulness intervention (COBMINDEX) is effective in reducing abdominal pain and fatigue in patients with CD and whether changes in abdominal pain and fatigue mediate any beneficial effects of COBMINDEX on impairments in work productivity and daily activities.

Methods: This is a secondary analysis of a parallel-group multicentre randomised controlled trial. Patients with mild-to-moderate CD (n = 142) were randomised into either intervention group receiving COBMINDEX, or control group receiving treatment-as-usual for 3 months followed by COBMINDEX. Complete data were collected from 120 patients (34.0 ± 10.7 years, 62.5% female, intervention = 60, control = 60). Analysis of covariance assessed group differences in 3-month follow-up scores, controlling for baseline scores. Multiple parallel mediation analysis assessed the proposed mechanisms for the entire sample.

Results: The intervention group demonstrated significantly lower levels of abdominal pain (F = 17.46, p < 0.001, η² _p = 0.13), fatigue (F = 7.26, p = 0.008, η² _p = 0.06) and impairments at work (F = 4.82, p = 0.032, η² _p = 0.07) and daily activities (F = 6.26, p = 0.014, η² _p = 0.05), compared with treatment-as-usual. Moreover, changes in abdominal pain and fatigue significantly mediated the beneficial effects of COBMINDEX on patients' work productivity (b = -9.90, SE = 2.86, 95% CI: -16.11 to -4.94) and daily activities (b = -9.65, SE = 1.91, 95% CI: -13.77 to 6.35), independent of changes in disease activity.

Conclusions: COBMINDEX is effective at reducing abdominal pain and fatigue in patients with CD, which in turn leads to improvement in functioning. Clinicians should incorporate screening for severe abdominal pain and fatigue and consider offering cognitive-behavioural and mindfulness training.

Clinicaltrials: gov, Number: NCT05085925. Ministry of Health in Israel (https://my.health.gov.il/CliniTrials/Pages/MOH_2020-02-24_008721.aspx).