Emotional State and Salivary Inflammatory Markers in Endometriosis Associated Pelvic Pain: A Pilot Study Comparing...

Women with endometriosis experience chronic cyclic pelvic pain (CCPP) or chronic persistent pelvic pain (CPPP), both of which may be incapacitating even after treatment. Emotional dysregulation in endometriosis impedes patient recovery. This study evaluated the relationships among emotional state, pain perception, and inflammatory biomarkers (IL-1β, IL-6, and TNF-α) in women with endometriosis presenting with CCPP or CPPP. An exploratory, observational, descriptive, cross-sectional, comparative with repeated sampling study was conducted with 52 women diagnosed with endometriosis and experiencing either CPPP or CCPP. Participants completed a psychometric battery including the State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI-II), Goldberg General Health Questionnaire (GHQ-30), Hospital Anxiety and Depression Scale (HADS), and Mini-Mental State Examination (MMSE). Pain perception was assessed using the Wong-Baker Pain Rating Scale (FACES). Saliva samples were collected at baseline, during stressor and recovery phases, and concentrations of IL-1β, IL-6, and TNF-α were determined by ELISA. Fifty-two women with endometriosis were included (CPPP: n = 33; CCPP: n = 19). No significant between group differences were observed in emotional state (HADS: p = 0.682; BDI: p = 0.842), anxiety (STAI-State: p = 0.086; STAI-Trait: p = 0.615), general distress (GHQ-30: p = 0.730), or pain intensity (FACES: p = 0.705). The prevalence of depressive symptoms did not differ between groups (CPPP: 69.7% vs. CCPP: 73.7%; χ² = 0.093, p = 0.760). Salivary cytokine levels (IL-1β, IL-6, TNF-α) were comparable between groups across all measurement conditions. Spearman correlations revealed uncorrected significance between TNF-α and emotional distress: basal TNF-α correlated inversely with HADS (ρ = -0.292, p = 0.031) and BDI (ρ = -0.278, p = 0.041); TNF-α under stress correlated with HADS (ρ = -0.329, p = 0.014) and GHQ-30 (ρ = -0.271, p = 0.046); and TNF-α during recovery correlated with GHQ-30 (ρ = -0.363, p = 0.006). These findings indicate that CPPP and CCPP were not associated with statistically significant differences in emotional states or salivary cytokine profiles at the group level. Exploratory pos hoc analyses suggested that pain pattern may moderate the association between TNF-α and psychological burden, particularly in the CCPP subgroup; however, these findings require confirmation in larger studies with prespecified analyses. Exploratory analyses suggested patterns between salivary inflammation and psychological burden; however, these findings should be interpreted cautiously because of the small subgroup size, multiple comparisons, and lack of a matched healthy control group.