Cognitive and Personality Factors Implicated in Pain Experience in Women With Endometriosis

Abstract

Objective: The impact of pain on quality of life and mental health of women with endometriosis is well known. However, the role that personality traits and coping strategies might have in influencing pain experience is still poorly understood and was the chief purpose of this study. Materials and Methods: We conducted a mixed-method sequential explanatory study, composed of a quantitative survey followed by qualitative interviews. The first quantitative phase included 162 women with endometriosis who completed a battery of validated questionnaires. After statistical analysis, a semistructured qualitative interview has been developed and conducted with 6 of them, in order to help explain findings obtained in the first phase. Thereafter, both analyses were combined in a metamatrix. Results: From the metamatrix, it emerged that acute pain experience, fear of its occurrence, its unpredictability, and control difficulties are the main concerns of women with endometriosis. Worry trait characteristics (ie, the need for control, anticipatory anxiety, intrusive worry thoughts) and maladaptive thoughts such as coping strategies (ie, self-blame, rumination, catastrophizing) were common in this sample and seem to indirectly affect pain experience. Indeed, the unsuccessful struggle in controlling pain reinforces negative thoughts/beliefs and feelings of powerlessness, leading, in turn, to psychological distress and higher pain experience. Discussion: From the study emerged a model of onset and maintenance of acute pain in women with endometriosis. Findings have clinical implications for the medical team and psychologists.

Psychosocial factors associated with pain and health‐related quality of life in Endometriosis: A systematic review

“…One study (Martin et al, 2011) was prospective and had a 12‐month follow‐up. A mixed‐method study was included (Zarbo et al, 2019), but only the quantitative data were extracted. The 27 included studies composed of 5419 participants in total.…”

“…Pain was assessed using numerical rating, visual analogue scales or the short‐form McGill pain questionnaire (SF‐MPQ) (Melzack, 1975). Given that studies used different terms to quantify pain (i.e., pain intensity or severity), albeit they used the SF‐MPQ (Carey et al, 2014; Martin et al, 2011; Zarbo et al, 2019), the terms pain intensity and pain severity were considered synonymous in this review. HRQoL was measured using the Endometriosis health profile‐30 (EHP‐30) (Jones et al, 2001) or the short‐form health survey (SF‐36) (Ware Jr & Sherbourne, 1992).…”

“…One study explored the association between pain and generalized worry, in which a positive correlation was found ( r = 0.32, p < 0.001) (Zarbo et al, 2019).…”

“…Three studies explored the association between pain and catastrophising in Endometriosis. Zarbo et al (2019) found that catastrophising was linked with greater pain at baseline ( r = 0.268, p < 0.001), whilst Martin et al (2011) reported that baseline catastrophising predicted pain severity at 12 months ( β = 0.18, p < 0.05, r 2 = 0.03). In both studies, the effect size of the association was small.…”

The State of Health and the Quality of Life in Women Suffering from Endometriosis

“…Some women may additionally feel fear of pain occurrence, strong need to control it, intrusive worry thoughts, catastrophizing, self-blame, and ruminations [ 35 ] ( Figure 2 ). Women with confirmed endometriosis experience significantly more symptoms of depression (standardized mean difference [SMD] of 0.71 (95% confidence interval [CI] 0.36–1.06)) and anxiety (SMD 0.60 (95% CI 0.35–0.84)) in comparison to healthy ones (SMD −0.01 (95% CI −0.17 to 0.15) for depression and SMD −0.02 (95% CI −0.22 to 0.18) for anxiety) [ 36 ].…”