The relationship between psychological factors and pain in endometriosis

Endometriosis is a prevalent condition characterized by persistent pelvic pain, which leads to distress and reduced quality of life. Currently, there is limited research examining the psychological factors associated with the symptoms of endometriosis, including potential risks and protective factors. The fear-avoidance model was identified to be a potential model to describe how psychological factors may impact the pain-related symptoms of endometriosis, informing the role that hypervigilance, pain catastrophizing, and avoidance behaviors play in increasing pain and distress. Previous research exploring this model identified self-efficacy and functionality appreciation as potential factors in reducing pain and distress in individuals with endometriosis.

The present study explores the fear-avoidance model's application to pain-related symptoms and health-related quality of life (HRQoL) in people with endometriosis, and the interaction between these variables to better understand the psychological processes linked to increased pain and HRQoL in individuals with endometriosis.

This study was cross-sectional observational design, with data collection and analysis conducted over the course of 6 months following ethics approval.

A total of 332 participants (female = 94%, male = 2.7%, non-binary/third gender = 3.3%) aged between 18 and 57 (M = 31.14, SD = 7.93) completed an online questionnaire assessing self-efficacy, functionality satisfaction, pain hypervigilance, pain catastrophizing, sexual avoidance and functioning, pain avoidance and pain severity. Correlational analysis, multiple linear regression and moderation analysis were conducted.

Functionality appreciation and self-efficacy were both associated with decreased pain and increased HRQoL. Hypervigilance functioned as an enhancing moderator for the relationship between sexual avoidance and pain, while pain catastrophizing acted as an enhancing moderator for the relationship between pain and HRQoL.

The overall findings of the present study revealed the expanded application of the fear-avoidance model, and its use in conceptualizing pain in endometriosis. This includes the role of functionality appreciation and self-efficacy as potential protective factors against increased pain in endometriosis. This study supports the development of interventions targeting hypervigilance, and pain catastrophizing as valuable strategies for pain management and improving HRQoL among individuals with endometriosis.