Pain, Emotions, Interoception, and Bodily Sensations in Patients With Endometriosis

Psychosocial aspects underlie and maintain persistent pain. Emotions have emerged as a target for psychological interventions in pain management. Our aim was to better understand the relationship between emotions and bodily sensations, including pain sensitivity, using two new approaches.

110 patients with confirmed endometriosis and 110 age- and gender-matched pain-free controls completed computer-based Bodily Sensation Maps for six basic emotions and a neutral emotional state, tactile, nociceptive, and hedonic sensitivities, as well as current and persistent pain. All participants also evaluated their current emotional experience of six basic emotions, depression, and anxiety, and answered the Brief Pain Inventory questionnaire; 102 endometriosis patients also answered the Multidimensional Assessment of Interoceptive Awareness questionnaire.

Endometriosis patients coloured in significantly larger painful areas on body maps and greater sensitivities to both nociceptive and hedonic sensations than did the pain-free controls. The endometriosis patients reported more current fear than controls but did not differ from controls in the colouring in of basic emotions on the body maps. Emotional awareness was associated with higher pain intensity, and with more colouring for persistent pain. More trusting was associated with less affective interference and with less colouring for current pain. Less worrying and more trusting were associated with more colouring for hedonic sensitivity.

Bodily sensation maps and multidimensional assessment of interoceptive awareness provide important information about the interface of emotions and pain. Our results suggest that a less worrying and a more trusting nature have a protective role in pain interference.

Bodily emotions and interoceptive awareness associate with sensitivity to pain and should be addressed when targeting emotions in pain management.