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. 2022 Oct;26(9):1827-1848.
doi: 10.1002/ejp.2006. Epub 2022 Jul 22.

Psychosocial factors associated with pain and health-related quality of life in Endometriosis: A systematic review

Michail Kalfas  1 , Claudia Chisari  1 , Sula Windgassen  1
Affiliations

Psychosocial factors associated with pain and health-related quality of life in Endometriosis: A systematic review

Michail Kalfas et al. Eur J Pain. 2022 Oct.

Abstract

Background and objective: Endometriosis is associated with pain and impaired health-related quality of life (HRQoL). Psychosocial factors have been associated with pain and HRQoL in other conditions, suggesting their potential relevance in Endometriosis. However, the role of psychosocial factors in this population has not been systematically explored yet. This systematic review aims to explore the association of psychosocial factors with pain intensity/severity and HRQoL in women with Endometriosis.

Databases and data treatment: Observational and experimental studies that explored the association of psychosocial factors with pain and HRQoL in women with Endometriosis were eligible. The following databases were searched: Medline, Embase, Cochrane library, Web of Science, PsychInfo and Cumulative index of nursing and allied health literature. The methodological quality was assessed, and findings were synthesized using narrative synthesis.

Results: Twenty-seven studies were eligible for inclusion, which included 5419 women with Endometriosis. Catastrophising and anxiety were the factors most consistently associated with greater pain, whilst depression, anxiety and stress were related to worse HRQoL. Findings regarding depression and pain were mixed, and research on social factors was limited.

Conclusions: This systematic review highlights the role of psychosocial factors in Endometriosis. Anxiety, depression and catastrophising are suggested as potential treatment targets. The review also indicates the lack of research on other potentially important psychosocial factors, such as avoidance, perceived injustice and social support.

Significance: This systematic review explored the role of psychosocial factors in Endometriosis, suggesting that these are associated with pain and health-related quality of life (HRQoL). Among the psychosocial factors included, anxiety, depression and catastrophising were the factors most often associated with pain and HRQoL in Endometriosis. These findings highlight the need to target psychological factors in the treatment of women with Endometriosis.

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Conflict of interest statement

None to declare.

Figures

FIGURE 1
FIGURE 1
Study flow diagram according to PRISMA 2020 (Page et al., 2021a, 2021b).
FIGURE 2
FIGURE 2
Summary figure of psychosocial factors in relation to pain and HRQoL in endometriosis. Green arrows represent positive associations; red arrows negative associations; double arrows bidirectional associations; solid arrows associations found in women with endometriosis; dotted arrows associations are hypothetical associations. Depression is associated with greater pain and worse HRQoL, whilst pain also impairs HRQoL. There is a bidirectional association between pain and depression, and pain and catastrophising. Note 1: HRQoL: Health‐related quality of life Note 2. Green arrows represent positive associations; red arrows represent negative associations; double arrows represent bidirectional associations; solid arrows reflect associations found in the included studies of women with Endometriosis; dotted arrows display hypothetical associations. Note 3: Depression is associated with greater pain and worse HRQoL, whilst pain also impairs HRQoL. There is a bidirectional association between pain and depression, and pain and catastrophising.
See this image and copyright information in PMC

References

    1. Abbott, J. , Hawe, J. , Hunter, D. , Holmes, M. , Finn, P. , & Garry, R. (2004). Laparoscopic excision of Endometriosis: A randomized, placebo‐controlled trial. Fertility and Sterility, 82, 878–884. 10.1016/j.fertnstert.2004.03.046 - DOI - PubMed
    1. Agar‐Wilson, M. , & Jackson, T. (2012). Are emotion regulation skills related to adjustment among people with chronic pain, independent of pain coping? European journal of pain (London, England), 16, 105–114. 10.1016/j.ejpain.2011.05.011 - DOI - PubMed
    1. Akkaya, N. , Akkaya, S. , Atalay, N. S. , Balci, C. S. , & Sahin, F. (2012). Relationship between the body image and level of pain, functional status, severity of depression, and quality of life in patients with fibromyalgia syndrome. Clinical Rheumatology, 31, 983–988. 10.1007/s10067-012-1965-9 - DOI - PubMed
    1. Ali, S. , Stone, M. , Skinner, T. C. , Robertson, N. , Davies, M. , & Khunti, K. (2010). The association between depression and health‐related quality of life in people with type 2 diabetes: A systematic literature review. Diabetes/Metabolism Research and Reviews, 26, 75–89. 10.1002/dmrr.1065 - DOI - PubMed
    1. Andysz, A. , & Merecz‐Kot, D. (2021). Predictors of illness acceptance in women with endometriosis. Health Psychology Report, 9(3), 240–251. 10.5114/hpr.2020.97914 - DOI - PMC - PubMed

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