Chronic Pelvic Pain in Women with Endometriosis is Associated with Psychiatric Disorder and Quality of Life Deterioration

Figures & data

Table 1 Characteristic of VAS, EHP-30, and Psychiatric Disorder in Women with Endometriosis-Associated Chronic Pelvic Pain

Variable	Distribution
VAS	8(3–10)*
-3–6 (Mild-moderate pain)	41 (25.6%) **
-7–10 (Severe-very severe pain)	119 (74.4%)
EHP-30
-Pain	63.63 (2.27–100)
-Control and powerless	54.16 (0–100)
-Emotional well-being	50 (0–100)
-Social Support	31.25 (0–75)
-Self-image	33.33 (0–91.67)
-Work	20 (0–100)
-Relationship with children	12.5 (0–100)
-Sexual Activity	20 (0–100)
-Medical profession	12.5 (0–81.25)
-Treatment	16.66 (0–83.33)
-Infertility	31.25 (0–100)
Total EHP-30 Score***	39.05 ± 14.74
Psychiatric Disorder
-Depression	45 (28.1%)
-Dysthymia	0 (0%)
-Manic	4 (2.5%)
-Agoraphobia	0 (0%)
-Panic	7 (4.4%)
-Social Phobia	0 (0%)
-Obsessive Compulsive	1 (0.6%)
-General Anxiety	33 (20.6%)
-PTSD	0 (0%)
-Bulimia	0 (0%)
-Anorexia	0 (0%)
-Alcohol Addiction	0 (0%)
-Drug Addiction	0 (0%)
-Psychotic	5 (3.1%)

Notes: *Presented as median (minimum-maximum). **Presented as frequency (percentage). ***Presented as mean ± standard deviation.

Abbreviations: VAS, Visual Analogue Scale; EHP-30, Endometriosis Health Profile; PTSD, Post Traumatic Stress Disorder.

Table 2 Univariate Analysis of the Pain Level (VAS)

Variable	VAS		p-value
	3–6 (Mild–Moderate Pain) (n = 41)	7–10 (Severe–Very Severe Pain) (n = 119)
Age (years)*
-<35	12 (18.8%)	52 (81.3%)	0.104^a
-≥ 35	29 (30.2%)	67 (74.4%)
Education
-0–12 years	31 (24.6%)	95 (75.4%)	0.569
->12 years	10 (29.4%)	24 (70.6%)
Surgical history
-Any surgical history	11 (13.6%)	70 (86.4%)	<0.001
-No surgical history	30 (38%)	49 (62%)
Parity
-0	17 (23.0%)	57 (77.0%)	0.263
–1	6 (15.8%)	32 (84.2%)
-˃1	18 (37.5%)	30 (62.5%)
Body Mass Index (BMI)
-Normal weight	25 (29.8%)	59 (70.2%)	0.014
-Overweight	16 (21.1%)	60 (78.9%)
Past medication history
-NSAID	23 (31.5%)	50 (68.5%)	0.119
-Hormonal	18 (20.7%)	69 (79.3%)
Psychiatric disorder			0.087
-Present	13 (18.8%)	56 (81.2%)
-Absent	28 (30.8%)	63 (69.2%)
Type of disorder**
-Depression	8	37
-Manic	1	3
-Agorapanic	0	7
-Obsessive compulsive	0	1
-General anxiety	8	25
-Psychotic	2	3
Depression			0.155
-Present	8 (17.8%)	37 (82.2%)
-Absent	33 (28.7%)	82 (71.3%)

Notes: *Presented as mean (±standard deviation). ** One subject may have multiple psychiatric disorders. ^aData analysis using coefficient contingency (significant if p <0.1).

Abbreviations: NSAID, Nonsteroidal Anti-Inflammatory Drugs; VAS, Visual Analogue Scale.

Table 3 Multivariate Analysis for Severe and Very Severe Pain (VAS 7–10) in Women with Endometriosis

Variable	OR (95% CI)	p-value*
Surgical history	3.571 (1.608–7.927)	0.002
Body Mass Index (BMI) Psychiatric Disorder	1.315 (0.612–2.824) 1.726 (0.792–3.763)	0.483 0.170

Note: * Only variables with univariate p-value <0.1 from logistic regression (Table 2) were included.

Abbreviation: VAS, Visual Analogue Scale.

Table 4 Univariate Analysis of Quality of Life

Variable	EHP-30 Score*	p-value
Age		0.897
-<35	39.23 (± 14.11)
-≥ 35	38.92 (± 15.22)
Education		0.163
-0–12 years	39.89 (± 14.08)
->12 years	35.91 (±16.83)
Surgical history		0.268
-Any surgical history	85.41 (± 3.27)
-No surgical history	80.10 (± 3.70)
Parity		0.194
-Nullipara	36.83 (± 14.64)
-Primipara	42.06 (± 14.36)
-Multipara	40.09 (± 14.97)
Body Mass Index (BMI)		0.002
-Normal weight	35.70 (±13.79)
-Overweight	42.75 (± 14.97)
Previous medication history		0.047
-NSAID	36.57 (± 12.75)
-Hormonal	41.13 (± 16.01)
VAS		<0.001
−3–6 (mild – moderate pain)	27.23 (± 13.44)
−7–10 (severe – very severe pain)	43.12 (± 12.90)
Psychiatric disorder		<0.001
-Present	96.47 (± 28.37)
-Absent	72.41 (± 29.43)
Type of disorder**
-Depression	50.51 (± 12.18)
-Manic	42.33 (± 13.59)
-Agorapanic	39.35 (± 7.78)
-General anxiety	41.59 (± 12.35)
-Psychotic	44.52 (± 17.43)

Notes: *Presented as mean (±standard deviation). **One subject may have multiple psychiatric disorders.

Abbreviations: EHP-30, (higher the values reflect lower the quality of life); NSAID, Nonsteroidal Anti-Inflammatory Drugs.

Table 5 Multivariate Analysis of Quality of Life (EHP-30 Score) in Endometriosis Patients

Variable	Unstandardized β Coefficient (95% CI)	p-value*
Body Mass Index	5.52 (1.82–9.27)	0.007
Previous medication history	2.97 (−0.78–6.77)	0.125
VAS	13.33 (9.01–17.65)	<0.001
Psychiatric disorder	9.84 (6.07–13.60)	<0.001

Note: *Only variables with univariate p-value <0.1 from linear regression (Table 4) were included.

Abbreviations: EHP-30, Endometriosis Health Profile (higher the values reflect lower the quality of life); VAS, Visual Analogue Scale.