Psychological factors mediate the relationship between trauma exposure and pain intensity in women with endometriosis: a cross-sectional study

Mariagrazia Merola, Stefano Cosma, Cosma S, Melotti C, Chiara Melotti, Elisa Aral, Aral E, Berchialla P, Paola Berchialla, Giulia Zanaga, Zanaga G, Giovanna Cacciato, Cacciato G, Tancredi A, Annalisa Tancredi, Luca Ostacoli, Ostacoli L, Benedetto C, Chiara Benedetto, Carletto S, Sara Carletto
Psychology, health & medicine · 2025 · vol. 31(6) , pp. 1–17 · doi:10.1080/13548506.2025.2564309 · PMID:41021895 · W4414687435
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This study found that depression and pain catastrophizing mediate the relationship between trauma exposure and pain intensity in women with endometriosis.

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Abstract

Endometriosis, a chronic inflammatory condition often characterized by chronic pelvic pain, significantly impacts women's quality of life. While psychological distress, including depression and anxiety, is prevalent in women with endometriosis, the influence of trauma exposure on pain perception remains poorly understood. Although previous research has shown that psychological factors can mediate the link between trauma and pain in other chronic pain conditions, this relationship has not yet been systematically investigated in women with endometriosis. This study therefore aimed to investigate whether psychological factors mediate the relationship between trauma exposure and pain intensity in women with endometriosis. A cross-sectional study was conducted in an Endometriosis outpatient referral center enrolling consecutive female patients with a clinical and/or histologic diagnosis of endometriosis. Clinical parameters, socio-demographic information, exposure to traumatic experiences, symptoms of depression, anxiety, post-traumatic stress, and pain catastrophizing levels were collected during gynecological examinations using specific questionnaires. Of the 156 women invited, 120 agreed to participate (response rate 76.9%). Nearly half of the participants reported clinically significant symptoms of depression and anxiety, while a quarter reported significant symptoms of post-traumatic stress and pain catastrophizing. Approximately half of the participants reported experiencing one or more traumatic events. The study confirmed the presence of a relationship between a history of trauma and pain perception; however, whilst no direct association was found between the two, symptoms of depression and pain catastrophizing were identified to act as mediators of the relationship between the two. The findings of this study highlight the complex interplay between trauma exposure, psychological symptoms and pain perception in women affected by endometriosis. Addressing these psychological aspects could offer a viable strategy for improving pain management and overall quality of life in women with endometriosis.
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ABSTRACT Endometriosis, a chronic inflammatory condition often characterized by chronic pelvic pain, significantly impacts women’s quality of life. While psychological distress, including depression and anxiety, is prevalent in women with endometriosis, the influence of trauma exposure on pain perception remains poorly understood. Although previous research has shown that psychological factors can mediate the link between trauma and pain in other chronic pain conditions, this relationship has not yet been systematically investigated in women with endometriosis. This study therefore aimed to investigate whether psychological factors mediate the relationship between trauma exposure and pain intensity in women with endometriosis. A cross-sectional study was conducted in an Endometriosis outpatient referral center enrolling consecutive female patients with a clinical and/or histologic diagnosis of endometriosis. Clinical parameters, socio-demographic information, exposure to traumatic experiences, symptoms of depression, anxiety, post-traumatic stress, and pain catastrophizing levels were collected during gynecological examinations using specific questionnaires. Of the 156 women invited, 120 agreed to participate (response rate 76.9%). Nearly half of the participants reported clinically significant symptoms of depression and anxiety, while a quarter reported significant symptoms of post-traumatic stress and pain catastrophizing. Approximately half of the participants reported experiencing one or more traumatic events. The study confirmed the presence of a relationship between a history of trauma and pain perception; however, whilst no direct association was found between the two, symptoms of depression and pain catastrophizing were identified to act as mediators of the relationship between the two. The findings of this study highlight the complex interplay between trauma exposure, psychological symptoms and pain perception in women affected by endometriosis. Addressing these psychological aspects could offer a viable strategy for improving pain management and overall quality of life in women with endometriosis. Acknowledgments The authors would like to thank all the women who participated in the study. They are also grateful to all the staff of the Endometriosis outpatient centre of “Sant’Anna - Città della Salute e della Scienza di Torino” University Hospital (Turin, Italy), and to Dr. Ilaria Quaranta and Dr. Lorena Giovinazzo (Clinical Psychology Unit, “Sant’Anna - Città della Salute e della Scienza di Torino” University Hospital, Turin, Italy) for their support in participant enrolment. The authors are also grateful to Stephanie Parsley for proofreading the manuscript. Author contributions Mariagrazia Merola: Conceptualization, Methodology, Data Curation, Writing – Original Draft; Writing – Review & Editing; Stefano Cosma: Conceptualization, Methodology, Writing – Original Draft; Writing – Review & Editing, Supervision, Project administration; Chiara Melotti: Investigation, Data Curation, Writing – Review & Editing; Elisa Aral: Investigation, Data Curation, Writing – Review & Editing; Paola Berchialla: Formal analysis, Visualization, Writing – Original Draft; Writing – Review & Editing; Giulia Zanaga: Formal analysis, Visualization, Writing – Original Draft; Writing – Review & Editing; Giovanna Cacciato: Writing – Review & Editing, Supervision, Funding Acquisition; Annalisa Tancredi: Writing – Review & Editing, Supervision; Luca Ostacoli: Writing – Review & Editing, Supervision, Funding Acquisition; Chiara Benedetto: Writing – Review & Editing, Supervision, Funding Acquisition; Sara Carletto: Conceptualization, Methodology, Writing – Original Draft; Writing – Review & Editing, Supervision, Project administration Disclosure statement No potential conflict of interest was reported by the authors. Data availability statement The data that support the findings of this study are available from the corresponding author upon reasonable request. Supplementary material Supplemental data for this article can be accessed online at https://doi.org/10.1080/13548506.2025.2564309

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Condition tags

endometriosischronic_pelvic_pain

MeSH descriptors

Anxiety Anxiety Anxiety Anxiety Anxiety Anxiety Anxiety Anxiety Anxiety Anxiety Anxiety Anxiety Anxiety Anxiety Anxiety Anxiety Anxiety Anxiety Anxiety Anxiety

Citation neighborhood

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