Interpretation bias in endometriosis-related pain

Abstract

Endometriosis-related pain has been predominantly medically managed, which has hindered understanding of psychological factors involved in these pain experiences. Models of chronic pain highlight the biased interpretation of ambiguous information as health threat related (interpretation bias) as an important process in the development and maintenance of chronic pain. Whether interpretation bias may also be similarly implicated in endometriosis-related pain is unclear. The current study aimed to address this gap in the literature by (1) comparing interpretation biases between a sample of participants with endometriosis and a control sample of participants without medical conditions and pain, (2) exploring relationships between interpretation bias and endometriosis-related pain outcomes, and (3) exploring whether interpretation bias moderated the relationship between endometriosis-related pain severity and pain interference. The endometriosis and healthy control samples comprised 873 and 197 participants, respectively. Participants completed online surveys assessing demographics, interpretation bias, and pain-related outcomes. Analyses revealed that interpretation bias was significantly stronger among individuals with endometriosis relative to controls, with a large effect size. Within the endometriosis sample, interpretation bias was significantly associated with increases in pain-related interference, however, interpretation bias was not associated with any other pain outcomes and did not moderate the relationship between pain severity and pain interference. This study is the first to evidence biased interpretation styles among individuals with endometriosis and to show this bias is associated with pain interference. Whether interpretation bias varies over time and whether this bias can be modified through scalable and accessible interventions to alleviate pain-related interference are avenues for future research.

Fear of progression, imagery, interpretation bias, and their relationship with endometriosis pain

“…These findings are consistent with the findings of the first-published study on interpretation bias in endometriosis. 27 This large study found that interpretation bias was associated with pain interference in people with endometriosis and also that those with endometriosis pain showed greater interpretation bias than an endometriosis-free Pearson correlations between endometriosis-specific imagery, fear of progression, and pain outcomes. 32 As such, interpretation bias and fear of progression may be useful targets for future interventions to reduce the impact of pain in endometriosis.…”

Benign or painful? The interpretation of pain and fear of progression in rheumatoid arthritis

“…Respondents receive a total interpretation bias score ranging from 0 to 14, with higher scores indicating greater levels of health-related interpretation bias. The Ambiguous Cues Task has been used in a range of different pain-related disorders, including people with heterogenous chronic pain, 42 endometriosis, 41 cancer-related pain, 43,44 diabetes-related pain, 60 acute pain, 59 and chronic fatigue. 35 In each of these samples, a health threat–related bias has been identified.…”

“…This tendency, labeled health-related interpretation bias, has been the subject of a small meta-analysis of 4 studies comparing people with and without chronic pain, which found a medium effect size (d 5 0.67), with several studies since confirming their importance in illness-related anxiety. 4,35,41,43,44,59,60 Although most research on FoP has been conducted on cancer, there is emerging evidence to suggest that it is a transdiagnostic construct. 54 Heathcote and Eccleston 16 proposed a model that explained fear of cancer recurrence (FCR), advocating that pain in the context of cancer requires interpretation because of the ongoing threat of recurrence.…”

“…This tendency, labeled health-related interpretation bias, has been the subject of a small meta-analysis of 4 studies comparing people with and without chronic pain, which found a medium effect size ( d = 0.67), with several studies since confirming their importance in illness-related anxiety. 4,35,41,43,44,59,60…”