The relationship between pain intensity and insomnia in women with deep endometriosis, a cross-sectional study

article OA: closed CC0 ⤵ 6 in-corpus citations
AI-generated summary by gemini-2.5-flash-lite+body, 2026-06-28

Moderate to severe pain in women with deep endometriosis significantly increased insomnia frequency, duration of pain, and low education levels were also associated with higher insomnia rates.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

AI-generated deep summary by claude@2026-07, 2026-07-09 · read from full text

This cross-sectional study investigated the relationship between pelvic pain intensity and insomnia frequency in 234 women diagnosed with deep endometriosis, using self-reported insomnia questionnaires and multiple logistic regression to adjust for confounders. The results showed that insomnia was uncommon among women without pain or with mild pain, while moderate and severe pain groups had much higher insomnia frequencies. In the regression model, moderate-to-severe pain increased the odds of insomnia 2.8 times, with additional increases associated with longer pain duration (about a twofold increase per 10 years) and lower education level. Because the study design is cross-sectional, it cannot establish temporal or causal relationships between pain and insomnia. This paper is centrally about endometriosis — it quantifies how pain intensity and duration in women with deep endometriosis relate to insomnia.

Read from the paper's body, not the abstract. Not a substitute for reading the paper. No clinical advice. How this works

Abstract

PurposeTo investigate the relationship between pain intensity and insomnia frequency in women with a diagnosis of deep endometriosis. The hypothesis is that these patients with moderate or severe pain have a higher frequency of insomnia than those with mild or no pain.MethodsWe conducted a cross-sectional study of women with deep endometriosis categorized by pelvic pain intensity based on a numerical scale. Insomnia was assessed through a self-reported questionnaire, and multiple logistic regression was used to control for confounders between pain and insomnia.ResultsWe included 234 women in the study, 39 (17%) without pelvic pain; 66 (29%) with mild pain; 53 (23%) moderate pain; and 76 (32%) severe pain. Twenty-nine (74%) pain-free women and 50 (75%) with mild pain had no insomnia; only 3 (8%) of the former and 3 (4%) of the latter group had severe insomnia. However, twenty-nine (55%) women with moderate pain and 37 (48%) with severe pain had insomnia. The logistic regression model showed that moderate to severe pain increased insomnia 2.8 times, twice for every 10 years of pain duration, and twice in women with low education levels.ConclusionsWomen with moderate or severe pain had a high frequency of insomnia, increasing management complexity in patients with deep endometriosis. Pain intensity, pain duration, and low education level increased the chance of insomnia in those patients.
Full text 8,950 characters · extracted from oa-doi-fallback · 5 sections · click to expand

Abstract

Purpose To investigate the relationship between pain intensity and insomnia frequency in women with a diagnosis of deep endometriosis. The hypothesis is that these patients with moderate or severe pain have a higher frequency of insomnia than those with mild or no pain.

Methods

We conducted a cross-sectional study of women with deep endometriosis categorized by pelvic pain intensity based on a numerical scale. Insomnia was assessed through a self-reported questionnaire, and multiple logistic regression was used to control for confounders between pain and insomnia.

Results

We included 234 women in the study, 39 (17%) without pelvic pain; 66 (29%) with mild pain; 53 (23%) moderate pain; and 76 (32%) severe pain. Twenty-nine (74%) pain-free women and 50 (75%) with mild pain had no insomnia; only 3 (8%) of the former and 3 (4%) of the latter group had severe insomnia. However, twenty-nine (55%) women with moderate pain and 37 (48%) with severe pain had insomnia. The logistic regression model showed that moderate to severe pain increased insomnia 2.8 times, twice for every 10 years of pain duration, and twice in women with low education levels.

Conclusions

Women with moderate or severe pain had a high frequency of insomnia, increasing management complexity in patients with deep endometriosis. Pain intensity, pain duration, and low education level increased the chance of insomnia in those patients. Similar content being viewed by others Data availability The datasets generated during and/or analyzed during the current study are not publicly available due to the sigil’s patient information. Still, they are available from the corresponding author on reasonable request.

References

Fauconnier A, Chapron C, Dubuisson J-B, Vieira M, Dousset B, Bréart G (2002) Relation between pain symptoms and the anatomic location of deep infiltrating endometriosis. Fertil Steril 78(4):719–726. https://doi.org/10.1016/S0015-0282(02)03331-9 Cornillie FJ, Oosterlynck D, Lauweryns JM, Koninckx PR (1990) Deeply infiltrating pelvic endometriosis: histology and clinical significance. Fertil Steril 53(6):978–983. https://doi.org/10.1016/S0015-0282(16)53570-5 Korwisi B et al (2021) Classification algorithm for the International Classification of Diseases-11 chronic pain classification: development and results from a preliminary pilot evaluation. Pain 162(7):2087–2096. https://doi.org/10.1097/j.pain.0000000000002208 Ahangari A (2014) Prevalence of chronic pelvic pain among women: an updated review. Pain Physician 2;17(2;3):E141–E147. https://doi.org/10.36076/ppj.2014/17/E141 Cosar E et al (2014) Sleep disturbance among women with chronic pelvic pain. Int J Gynecol Obstet 126(3):232–234. https://doi.org/10.1016/j.ijgo.2014.03.034 Alvarez P et al (2012) Ectopic uterine tissue as a chronic pain generator. Neuroscience 225:269–282. https://doi.org/10.1016/j.neuroscience.2012.08.033 Karaman S, Karaman T, Dogru S, Onder Y, Citil R, Bulut YE, ... Suren M (2014) Prevalence of sleep disturbance in chronic pain. Eur Rev Med Pharmacol Sci 18(17):2475–2481 Irwin MR, Carrillo C, Olmstead R (2010) Sleep loss activates cellular markers of inflammation: Sex differences. Brain Behav Immun 24(1):54–57. https://doi.org/10.1016/j.bbi.2009.06.001 Amtmann D, Bamer AM, Askew R, Jensen MP (2020) Cross-lagged longitudinal analysis of pain intensity and sleep disturbance. Disabil Health J 13(3):100908. https://doi.org/10.1016/j.dhjo.2020.100908 Athar W et al (2020) Obstructive sleep apnea and pain intensity in young adults. Ann Am Thorac Soc 17(10):1273–1278. https://doi.org/10.1513/AnnalsATS.201910-750OC Arion K et al (2020) A quantitative analysis of sleep quality in women with endometriosis. J Womens Health 29(9):1209–1215. https://doi.org/10.1089/jwh.2019.8008 Gdańska P, Drozdowicz-Jastrzębska E, Grzechocińska B, Radziwoń-Zaleska M, Węgrzyn P, Wielgoś M (2017) Anxiety and depression in women undergoing infertility treatment. Ginekol Pol 88(2):4 Mathias JL, Cant ML, Burke ALJ (2018) Sleep disturbances and sleep disorders in adults living with chronic pain: a meta-analysis. Sleep Med 52:198–210. https://doi.org/10.1016/j.sleep.2018.05.023 Said EA et al (2019) Sleep deprivation alters neutrophil functions and levels of Th1-related chemokines and CD4+ T cells in the blood. Sleep Breath 23(4):1331–1339. https://doi.org/10.1007/s11325-019-01851-1 Bazot M, Daraï E (2017) Diagnosis of deep endometriosis: clinical examination, ultrasonography, magnetic resonance imaging, and other techniques. Fertil Steril 108(6):886–894. https://doi.org/10.1016/j.fertnstert.2017.10.026 Bastien C (2001) Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med 2(4):297–307. https://doi.org/10.1016/S1389-9457(00)00065-4 Leone Roberti Maggiore U et al (2017) Symptomatic endometriosis of the posterior cul-de-sac is associated with impaired sleep quality, excessive daytime sleepiness and insomnia: a case–control study. Eur J Obstet Gynecol Reprod Biol 209:39–43. https://doi.org/10.1016/j.ejogrb.2015.11.026 Dworkin RH et al (2012) Considerations for improving assay sensitivity in chronic pain clinical trials: IMMPACT recommendations. Pain 153(6):1148–1158. https://doi.org/10.1016/j.pain.2012.03.003 Gagnon C, Belanger L, Ivers H, Morin CM (2013) Validation of the insomnia Severity Index in primary care. J Am Board Fam Med 26(6):701–710. https://doi.org/10.3122/jabfm.2013.06.130064 Dragioti E, Wiklund T, Alföldi P, Gerdle B (2015) The Swedish version of the Insomnia Severity Index: factor structure analysis and psychometric properties in chronic pain patients. Scand J Pain 9(1):22–27. https://doi.org/10.1016/j.sjpain.2015.06.001 Wu Y-L, Chang L-Y, Lee H-C, Fang S-C, Tsai P-S (2017) Sleep disturbances in fibromyalgia: a meta-analysis of case-control studies. J Psychosom Res 96:89–97. https://doi.org/10.1016/j.jpsychores.2017.03.011 Laganà AS et al (2017) Anxiety and depression in patients with endometriosis: impact and management challenges. Int J Womens Health 9:323–330. https://doi.org/10.2147/IJWH.S119729 Hida M et al (2020) Effects of the characteristics and duration of chronic pain on psychosomatic function in the community-dwelling elderly population. Pain Res Manag 2020:1–5. https://doi.org/10.1155/2020/4714527 Ghai V, Jan H, Shakir F, Haines P, Kent A (2020) Diagnostic delay for superficial and deep endometriosis in the United Kingdom. J Obstet Gynaecol 40(1):83–89. https://doi.org/10.1080/01443615.2019.1603217 Aily JB, de Almeida AC, Ramírez PC, da Silva Alexandre T, Mattiello SM (2021) Lower education is an associated factor with the combination of pain catastrophizing and kinesiophobia in patients with knee osteoarthritis? Clin Rheumatol 40(6):2361–2367. https://doi.org/10.1007/s10067-020-05518-1 Stroemel-Scheder C, Kundermann B, Lautenbacher S (2020) The effects of recovery sleep on pain perception: a systematic review. Neurosci Biobehav Rev 113:408–425. https://doi.org/10.1016/j.neubiorev.2020.03.028 Morin CM et al (2015) Insomnia disorder. Nat Rev Dis Primer 1(1):15026. https://doi.org/10.1038/nrdp.2015.26 Laganà AS et al (2017) Clinical dynamics of Dienogest for the treatment of endometriosis: from bench to bedside. Expert Opin Drug Metab Toxicol 13(6):593–596. https://doi.org/10.1080/17425255.2017.1297421 Author information Authors and Affiliations Contributions De Souza, R. J.: work design; data collection, analysis, and interpretation; draft, discussion, and review. Oliveira, M.A.P.: work design; data analysis and interpretation; and review. Vilella, N. R.: results interpretation; discussion; and review. Corresponding author Ethics declarations Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (The University of the State of Rio de Janeiro—CAAE: 18261019.4.0000.5259) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent Informed consent was obtained from all individual participants included in the study. Conflict of interest The authors declare no competing interests. Additional information Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Synopsis Women with deep endometriosis experiencing moderate or severe pain have a high frequency of insomnia. Low education level and pain duration also play a role in this relationship. Rights and permissions About this article Cite this article de Souza, R.J., Vilella, N.R. & Oliveira, M.A.P. The relationship between pain intensity and insomnia in women with deep endometriosis, a cross-sectional study. Sleep Breath 27, 441–447 (2023). https://doi.org/10.1007/s11325-022-02622-1 Received: Revised: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s11325-022-02622-1

Text is read by the "Ask this paper" AI Q&A widget below. Extraction quality varies by source — PMC NXML preserves structure cleanly, OA-HTML may include some navigation residue, and OA-PDF can have broken hyphenation. The publisher copy (via DOI) is the canonical version.

My notes (saved in your browser only)

Ask this paper AI returns verbatim quotes from the full text · source: oa-doi-fallback

Answers must be backed by verbatim quotes from this paper's full text. Hallucinated quotes are dropped automatically; if no verbatim passage answers the question, we say so. How this works

Condition tags

endometriosischronic_pelvic_pain

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Cross-Sectional Studies

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (28)

Cited by (6)

Source provenance

europepmc
last seen: 2026-09-05T06:14:40.014199+00:00
openalex
last seen: 2026-06-10T17:14:06.276822+00:00
pubmed
last seen: 2026-06-04T00:34:54.200900+00:00
License: CC0 · commercial use OK