The pain experience of women with endometriosis may indirectly be influenced by worry traits and maladaptive thoughts, according to study results published in The Clinical Journal of Pain.

In this mixed-method sequential explanatory study of 162 women with endometriosis, participants were asked to complete a battery of quantitative questionnaires regarding their characteristics, lifestyle, and pain experience in the first phase. In the second phase, a semi-structured qualitative interview was conducted on 6 participants from the original cohort.

The quantitative analyses indicated significant associations between a majority of the measures assessed, with, in particular, a correlation between pain severity in the previous 3 months and worry traits, self-blame, and catastrophizing. Participants reporting high vs low levels of pain had higher scores on worry traits (P <.001), rumination (P =.035), and catastrophizing (P =.011).

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The qualitative analysis indicated that the greatest stressors and concerns for the 6 women with endometriosis interviewed were the experience of acute pain, the persistent fear of its unpredictable occurrence, and difficultly controlling the pain. To cope with the pain and the coinciding intrusive thoughts, women reported employing a number of strategies, many of which were unsuccessful. When controlling pain does not work, participants reported their negative thoughts being reinforced and feeling powerless, leading to psychological distress and anxiety.

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Study limitations include the small sample size of the qualitative analysis phase.

“The nucleus of worry personality…seems to be relevant and should be considered as a risk factor when taking into account women with endometriosis. In particular, worthy of attention in this context are the negative metacognitive beliefs related to the uncontrollability of thoughts and their relationship with psychological distress,” noted the study authors.


Zarbo C, Brugnera A, Dessi V, et al. Cognitive and personality factors implicated in pain experience in women with endometriosis: a mixed method study [published online August 19, 2019]. Clin J Pain. doi:10.1097/AJP.0000000000000757

This article originally appeared on Clinical Pain Advisor