The pelvic pain bias assessment: a new assessment of interpretation bias specific to pelvic pain

Pelvic pain is a common and often debilitating experience with limited treatment options. Improving understanding of the psychosocial mechanisms involved in pelvic pain experiences will enhance the efficacy of pain management interventions. Interpretation bias is a promising psychosocial factor in leading models of chronic pain, yet its relevance for pelvic pain remains poorly understood. The current study sought to assess disorder specific interpretation bias in people with endometriosis and other pelvic pain-related conditions. To do so, we developed a new interpretation bias assessment tool based on existing literature and used this to investigate interpretation bias and relationships with pain, menstrual symptoms, and psychological distress across pelvic pain-related conditions. The sample comprised 342 individuals including those with endometriosis, adenomyosis, chronic pelvic pain, polycystic ovarian syndrome, and those without pelvic pain-related conditions. Participants completed an online survey including demographics, new and modified interpretation bias scenarios, pain-related outcomes, and psychological distress. After a rigorous item selection process, 27 ambiguous pelvic pain-related scenarios were retained, forming the Pelvic Pain Bias Assessment (PPBA). Using the PPBA, we replicated our previous finding of elevated interpretation bias among individuals with endometriosis relative to controls and found interpretation bias was also elevated among individuals with other pelvic pain-related conditions relative to controls. Stronger interpretation bias was associated with worse pelvic pain and menstrual symptoms among individuals with and without pelvic pain-related conditions. This study adds to the growing evidence that interpretation bias is associated with a range of pain conditions and poorer pain-related outcomes in pelvic pain.