Psychological Factors in Chronic Pelvic Pain due to Endometriosis: A Comparative Study

Abstract

Background/Aims: This study compared women suffering chronic pelvic pain (CPP) secondary to endometriosis (n = 30) with women experiencing CPP due to either myofascial abdominal/pelvic pain (n = 70) or pelvic adhesions (n = 38) to determine if there are specific psychological variables uniquely associated with endometriosis. Methods: This is a cross-sectional study of 138 women drawn from a convenience sample of 192 consecutive women with CPP presenting for evaluation to a university hospital chronic pain clinic. Subjects were categorized into groups based on their CPP diagnosis. Each subject completed a battery of validated inventories assessing demographic status, pain experience and other pain-related symptoms, pain disability, frequency of depressive symptoms, level of affective distress, satisfaction with pain treatment and satisfaction with their marital relationship. Results: No differences were obtained across the three groups for any of the outcome measures. Effect size computation supported the absence of clinical differences across the groups for these measures. Conclusion: These findings fail to support the presence of a unique psychological profile or disproportionate psychological disturbance for women with CPP due to endometriosis. These data illustrate the importance of considering control groups that include chronic pain when exploring psychological contributions to specific chronic pain conditions.

Associations between chronic pelvic pain and psychiatric disorders and symptoms

“…Another investigation found equivalent rates of depression and anxiety in subjects with CPP and migraine 21 , and two others found no differences when comparing CPP groups with different etiologies 27,37 .…”

“…From these, five studies [24][25][26][27][28] used an observational descriptive design and the remaining 13 8,20,21,[29][30][31][32][33][34][35][36][37][38] used a case-control design. Most of the studies were conducted in the United States (n = 6) and Brazil (n = 5).…”

“…The most frequent inclusion criteria for the clinical groups were duration of pain symptoms 8,20,21,[24][25][26][27]29,[31][32][33][34][35][36] , which ranged from three to six months, and specificities related to the etiology of pain 21,27,[31][32][33][34]36,37 , for example, pain resulting from pelvic adhesions. It is noteworthy that not all studies strictly followed the international criteria for the diagnosis of CPP, which require a minimum duration of six months for pain symptoms [9][10][11][12][13] .…”

Endometriosis-associated pain syndrome: a nurse-led approach

“…11 A large 5-year Australian 12 exploratory study suggested that there might be an associated risk of endometriosis for those women who have worked as a flight attendant, service station attendant or health worker, particularly a nurse. However other findings 13 fail to support the presence of a unique psychological profile or even a disproportionate psychological disturbance in women with chronic pelvic pain due to endometriosis; in addition, no differences were obtained for ratings of depression, anxiety, mood factors or additional personality traits. These data suggest that, in general, when psychological disorders are observed in chronic pelvic pain patients, they most likely reflect the effects of chronic pain rather being causative of it.…”

Psychological Strategies in Pain Management: Optimizing Procedures in Clinics

“…These tools can help to identify psychological problems at early period that is crucial for understanding the development of acute pain into chronic and also possibly preventing its chronicity. Several studies considered psychological factors are contributors to patients' chronicity, but others did not find such a relationship (Roth et al, 2011a;Roth et al, 2011b;Roth et al, 2011c;Wallin et al, 2011;Xu et al, 2011). Various results in different studies questioned the real analgesic effect of psychological approaches in chronic pain management.…”