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

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.