PROJECT SUMMARY One in ten U.S. women suffer from chronic pelvic pain, a condition that can lead to depression, social isolation, sexual dysfunction, physical inactivity, and dependence on or abuse of pain medications. Unfortunately, most medications used to manage pelvic pain have problematic side effects or addictive potential, and other clinical therapies for this condition depend on costly, one-on-one visits with specialized healthcare practitioners. As a result, many women suffering from chronic pelvic pain are anxious to identify alternative treatment strategies that are not only effective, but also better tolerated and more accessible. Yoga is a set of complementary physical and mental practices with the potential to improve chronic pelvic pain through multiple mechanisms. When practiced in a way that emphasizes careful anatomic alignment, mindful awareness of bodily structures, and deep breathing during the practice of yoga postures, yoga can be used to improve pelvic floor dysfunction, correct maladaptive postural and physical behaviors, and decrease comorbid anxiety and perceived stress. As a result, regular practice of yoga has the potential to improve multiple factors that can precipitate and exacerbate pelvic pain or worsen pain-related disability. To explore the feasibility of teaching women to practice yoga to improve chronic pelvic pain, our investigative team previously collaborated with an expert yoga panel to develop a structured, group-based yoga program for this indication, involving twice weekly group classes supplemented by once weekly home yoga practice. In a small single-arm pilot study involving women suffering from pelvic pain for at least 6 months, adherence to group classes and home practice was high, and women reported substantial improvements in pain severity and pain-related quality of life over 6 weeks. We now propose to conduct a follow-up randomized pilot trial to evaluate the feasibility of conducting a rigorous randomized trial of a refined, 8-week version of this yoga program. Approximately 40 women with chronic pelvic pain will be recruited from three locations and randomly assigned to take part in a group yoga program consisting of twice-weekly group classes and once weekly home practice focused on study-specific yoga techniques, versus a control program involving time-equivalent group classes and home practice of non- specific muscle stretching and strengthening exercises. Using data collected during and after the intervention programs, we will assess retention and adherence to group classes and home practice, evaluate participant self-efficacy and observed success in learning to practice intervention techniques, and examine rates of data completion and data quality derived from pain-related outcome measures. This research is an important next step toward future, rigorous evaluation of the efficacy and safety of yoga as a potentially patient-centered, community-based self-management strategy for chronic pelvic pain.

PROJECT NARRATIVE The proposed research addresses the urgent need for more effective, accessible, and patient-centered treatment strategies for chronic pelvic pain as a common and debilitating pain syndrome in women. If successful, this research may pave the way for women suffering from chronic pelvic pain to use yoga to improve their pain-related functioning in community settings, while also repeating other potential benefits for their long-term health.