Post-Treatment Endometriosis Pain Distress Syndrome (PEPDS): definition, symptoms, diagnostic criteria and questionnaire

PEPDS (Post-Treatment Endometriosis Pain Distress Syndrome) is a proposed clinical construct describing persistent (at least 3 months) pain-related and emotional distress in people after completed surgical and/or hormonal treatment of endometriosis. Pain, fear of pain or recurrence, catastrophizing, medical trauma and digital information stress reinforce one another and impair daily functioning. The construct integrates the biopsychosocial model of pain, the fear-avoidance model and the theory of fear of disease recurrence. The central idea: after endometriosis treatment, some people remain in a “threat mode”. This may be driven by real residual pain, central sensitization or recurrence, as well as by learned pain anticipation, distrust of healthcare and an information environment (social media, search engines, AI chatbots) that can both support and amplify anxiety. Post-Treatment Endometriosis Pain Distress Syndrome (PEPDS) is a proposed clinical construct describing persistent pain-related and emotional distress (≥3 months) after completed surgical and/or hormonal treatment of endometriosis, characterised by pain anticipation, fear of recurrence, pain catastrophizing, medical trauma and digital information stress (social media and AI chatbot use), with functional impairment. It is not an established ICD-11 or DSM-5 diagnosis and requires validation.