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Davenport RA, Krug I, Dang PL, Rickerby N, Kiropoulos L. Neuroticism and cognitive correlates of depression and anxiety in endometriosis: A meta-analytic review, evidence appraisal, and future recommendations. J Psychosom Res 2024; 187:111906. [PMID: 39236356 DOI: 10.1016/j.jpsychores.2024.111906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 08/22/2024] [Accepted: 08/26/2024] [Indexed: 09/07/2024]
Abstract
OBJECTIVE This meta-analytic review aimed to synthesise evidence on personality and cognitive factors related to depression and anxiety in endometriosis and determine whether sociodemographic and clinical variables moderate factor-symptom relations. Additionally, this review aimed to evaluate the quality of research and formulate recommendations for future research. METHODS A systematic search was conducted across databases (Medline, Embase, PsycInfo, Web of Science, ProQuest) through to February 2024. Search terms were used for endometriosis, depression, anxiety, cognitive factors and personality traits. Random-effects meta-analyses were conducted to produce pooled weighted effects (r) for factor-symptom relationships. RESULTS Thirteen studies (11 samples; N = 3287; Mage 33.89 ± 2.48) were included in a narrative synthesis. One study provided evidence for a positive association between neuroticism and depression. Seven studies contributed to meta-analyses on three cognitive factors. Medium-to-large associations were identified between illness perceptions of low control/power (r = 0.35, 95 % CI: 0.01,0.62), rumination (r = 0.52, 95 % CI: 0.09, 0.78), pain-catastrophising (r = 0.37, 95 % CI: 0.28, 0.45) and higher levels of depression. The statistical power to detect significant effects was >80 %. Findings for anxiety were non-significant, although limited data were available. Quality appraisal revealed a high risk of within-study bias (4.69 ± 1.38, range: 3-7), with issues related to sample representativeness and measurement selection. CONCLUSION Rumination, pain-catastrophising, and illness perceptions of low control/power are important in understanding depression in endometriosis. There is a lack of research on personality traits, necessitating further study. Findings highlight the importance of prioritising modifiable cognitive factors in psychological research and clinical practice in endometriosis.
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Affiliation(s)
- R A Davenport
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia.
| | - I Krug
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - P L Dang
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - N Rickerby
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - L Kiropoulos
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
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Mazur-Bialy A, Tim S, Pępek A, Skotniczna K, Naprawa G. Holistic Approaches in Endometriosis - as an Effective Method of Supporting Traditional Treatment: A Systematic Search and Narrative Review. Reprod Sci 2024:10.1007/s43032-024-01660-2. [PMID: 39043999 DOI: 10.1007/s43032-024-01660-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 07/16/2024] [Indexed: 07/25/2024]
Abstract
Endometriosis is one of the gynecological diseases where women suffer from pain, quality of life decreased. The aim of this review was to describe the most common non-medical methods used in the treatment of symptoms associated with endometriosis and to determine their effectiveness. The review was performed in PubMed, Embase and Web of Science databases. Randomized controlled trials, case studies, observational studies, retrospective studies, prospective studies, pilot studies, trails, publications in English or Polish were searched based on the Participant-Intervention-Comparator-Outcomes-Study design (PICOS) format. The criteria used to select studies were: women with endometriosis, no cancer, included any physiotherapeutic or non-medical intervention. 3706 articles were found, however only 26 met the inclusion criteria and were included in the review. Quality of the studies was assessed by Risk of Bias 2 tool and ROBINS-1 tool. The most holistic approach used in the treatment of symptoms of endometriosis include physical therapy, manual therapy, electrophysical agents acupuncture, diet and psychological interventions. Most research has focused on relieving pain and increasing quality of life. Non-medical methods showed reduction of symptoms of endometriosis. Physical activity, manual therapy, electrophysical agents, acupuncture, diet and cognitive behavioral therapy showed no negative side effects and reduced pain, what improved the quality of life and reduced the perceived stress.
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Affiliation(s)
- Agnieszka Mazur-Bialy
- Department of Biomechanics and Kinesiology, Faculty of Health Science, Jagiellonian University Medical College, Skawińska 8, Krakow, 31-066, Poland.
| | - Sabina Tim
- Department of Biomechanics and Kinesiology, Faculty of Health Science, Jagiellonian University Medical College, Skawińska 8, Krakow, 31-066, Poland
| | - Anna Pępek
- Student Scientific Group, Faculty of Health Science, Jagiellonian University Medical College, Krakow, Poland
| | - Kamila Skotniczna
- Student Scientific Group, Faculty of Health Science, Jagiellonian University Medical College, Krakow, Poland
| | - Gabriela Naprawa
- Student Scientific Group, Faculty of Health Science, Jagiellonian University Medical College, Krakow, Poland
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McKnight K, Omotosho O, Jassim S, Cotter A. Exercise and endometriosis-is there a promising future? A narrative review. Ir J Med Sci 2024:10.1007/s11845-024-03733-2. [PMID: 38916808 DOI: 10.1007/s11845-024-03733-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 06/04/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Endometriosis is the leading cause of chronic pelvic pain in women of reproductive age with debilitating effects on quality of life, yet no cure exists. Exercise yields the potential in providing women with a non-invasive, non-pharmacological method of symptom control. AIM(S) Present up-to-date knowledge regarding how exercise may contribute to the management of endometriosis-related symptoms. OBJECTIVE(S) Discuss: 1. The pathophysiology surrounding exercise and endometriosis. 2. The role of exercise in endometriosis symptom control. RATIONALE Scientific literature has alluded to exercise being a favourable factor in the management of endometriosis-related symptoms. Moreover, current clinical guidelines for endometriosis fail to reflect the aforementioned benefits of exercise. SEARCH STRATEGY A search strategy using the terms 'endometriosis', 'endometriomas', 'exercise', and 'physical activity' was devised. Pubmed, Medline, Cochrane reviews, and Embase were reviewed. INCLUSION CRITERIA Interventional studies, within-subjects studies, randomised-control trials, systematic reviews, meta-analysis, cohort studies, publication since 2000. EXCLUSION CRITERIA Non-English publications, non-human studies. RESULTS Numerous studies have suggested positive effects for endometriosis patients who performed exercise exclusively or in conjunction with other therapies. Improvements in pain levels, quality of life, anxiety, and depression were noted. DISCUSSION Current research outlines promise regarding the potential benefit of exercise prescribing in patients with endometriosis as well as a synergy between exercise and hormonal therapies for the management of endometriosis-related symptoms. However, the current paucity of high-quality robust studies investigating these aspects of endometriosis management is an apparent obstacle to progression in this area. CONCLUSION For clinicians to incorporate exercise in managing endometriosis, clear recommendations regarding advice and benefits are needed.
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Affiliation(s)
- Kathryn McKnight
- Univerisity Hospital Galway, Galway, Ireland.
- School of Medicine, University of Limerick, Limerick, Ireland.
| | | | | | - Amanda Cotter
- Univerisity Hospital Galway, Galway, Ireland
- University Maternity Hospital Limerick (UMHL), Limerick, Ireland
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Osaki JD, Oliveira MAP. What Is Behind? Impact of Pelvic Pain on Perceived Stress and Inflammatory Markers in Women with Deep Endometriosis. J Clin Med 2024; 13:2927. [PMID: 38792467 PMCID: PMC11122144 DOI: 10.3390/jcm13102927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/14/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Introduction/Objectives: Endometriosis affects 10% of women worldwide. It is noteworthy that this condition is often accompanied by pelvic pain and stress. Endometriosis is a debilitating gynecological condition where tissue similar to the uterine lining grows outside the uterus, often causing significant pain and reproductive issues. We aimed to study the relationship between the intensity of pelvic pain, and stress and inflammatory markers in women with deep endometriosis. Methods: This cross-sectional study analyzed women diagnosed with deep endometriosis through imaging, surgery, and/or biopsy. We assessed pain using the Numerical Rating Scale (NRS). Stress was assessed with the Perceived Stress Scale (PSS-10) questionnaire and the serum cortisol levels. Additionally, we analyzed inflammatory markers, including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Results: Fifty-two women, with an average age of 37.8 ± 6.9 years, participated in this study. Forty-four percent of these participants demonstrated high levels of stress, as indicated by scores above 26 on the PSS-10. Those categorized with "high stress" on the PSS-10 questionnaire exhibited significantly higher pain levels compared to those with "low stress" (p < 0.05). Furthermore, patients experiencing more-severe pelvic pain (pain score > 7) had notably higher serum cortisol levels. Women with intense pelvic pain (scores above 7 on the NRS) had significantly elevated serum cortisol levels (Cohen's d = 0.72; p = 0.018). Conclusions: A positive association was found between stress levels and the intensity of pelvic pain in women with deep endometriosis, suggesting an interconnection between emotional aspects and biological responses.
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Affiliation(s)
- Jordana Diniz Osaki
- Núcleo Avançado de Endometriose e Robótica, Hospital DF Star, Brasília 70390-140, Brazil
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Donatti L, Podgaec S, Baracat EC. Efficacy of Cognitive Behavioral Therapy in treating women with endometriosis and chronic pelvic pain: A randomized trial. J Health Psychol 2024:13591053241240198. [PMID: 38566501 DOI: 10.1177/13591053241240198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
This study seeks to assess the efficacy of Cognitive-Behavioral Therapy (CBT) in enhancing coping strategies, alleviating depression, stress, pain perception, and improving the quality of life for women with endometriosis. About 52 patients randomized, categorized into an intervention group (n = 25) and a control group (n = 27) filled out the instruments. A significant positive change was observed in all variables studied within the intervention group compared to the control group. This study introduced a psychological treatment protocol focused on refining coping strategies using CBT techniques. Following the promotion of adaptive coping, there was an improvement in scores related to depression, stress, quality of life, perception of pain, and emotional distress. This suggests that CBT is effective in enhancing the overall emotional wellbeing of women with endometriosis.
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Affiliation(s)
- Lilian Donatti
- Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Brazil
| | - Sergio Podgaec
- Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Brazil
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Oberegger E, Taxer B. [Physiotherapeutic differential diagnosis of back pain associated with endometriosis]. Schmerz 2024:10.1007/s00482-024-00795-0. [PMID: 38393352 DOI: 10.1007/s00482-024-00795-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Endometriosis (EM) is one of the most common gynecologic conditions in our society. The diagnosis takes an average of 7 to 10 years. To shorten this period, this syndrome needs more attention. The aim of this article is to show overlaps between EM and low back pain (LBP) and to describe their relevance for physiotherapeutic screening. OBJECTIVES What clinical signs do the syndromes EM and LBP have in common and to what extent can physiotherapeutic screening take gynecological aspects into account and be adapted accordingly? RESULTS To answer this question, the two syndromes were screened for overlaps. These overlaps were then related to the existing literature and case studies. The current research situation shows overlaps of the two syndromes with regard to the etiology, the pain mechanism as well as a psychosocial aspect. The literature shows that more women than men are affected by LBP and other chronic pain syndromes. EM occurs almost exclusively in women and, like LBP, is considered a chronic pain syndrome. Thus, a common pain mechanism of the two syndromes is discussed in the literature. The most frequent overlap of the two syndromes is shown by the occurrence of LBP as a frequent symptom of EM. This connection can be justified by structural causes as well as by a reflex pain presentation. CONCLUSION In a physiotherapeutic setting, evidence of EM can be observed in the history and physical examination. Considering these factors may help shorten the diagnosis time of endometriosis by referring for further evaluation if gynecologic involvement is suspected in LBP. A comprehensive history is important and should cover urologic, gynecologic, as well as sexual history. In this article, the term woman is used to refer to the biological female sex and is not related to individual gender identity. The clinical picture mainly affects women, which is why in the following work, as far as it concerns the people suffering from the disease, it is not used in the opposite sense.
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Affiliation(s)
| | - Bernhard Taxer
- Studiengang PTH, FH JOANNEUM Graz, Eggenberger Allee 13, 8020, Graz, Österreich.
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Moreira MDF, Gamboa OL, Oliveira MAP. Mindfulness intervention effect on endometriosis-related pain dimensions and its mediator role on stress and vitality: a path analysis approach. Arch Womens Ment Health 2024; 27:45-55. [PMID: 37848766 DOI: 10.1007/s00737-023-01381-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/09/2023] [Indexed: 10/19/2023]
Abstract
Endometriosis-related pain is supposedly mainly responsible for generating psychological stress and deteriorating the quality of life. However, the interaction between these factors has not been investigated, considering its multidimensional nature and through the path of effects of psychosocial approaches. The present study aims to investigate the effect of a brief mindfulness-based intervention (bMBI) on pain dimensions and its mediator role on psychological stress and QoL-Vitality improvement. A secondary analysis of a pilot randomized controlled trial using a series of parallel and serial mediators was carried out. The results showed that bMBI improves the sensory (B = -6.09 [-9.81, -2.52], β = -0.42) and affective (B = -3.40 [-5.02, -1.80], β = -0.47) pain. The bMBI effect on psychological stress reduction was mediated by these changes in sensory (B = -2.81 [-6.06, -0.41], β = -0.21) and affective (B = -1.97 [-5.07, -0.17], β = -0.15) pain. Serial sensory pain and psychological stress reduction (B = 2.27 [0.11, 5.81], β = -0.09) mediated the bMBI effect on quality of life vitality. Meditation training promotes additional improvement in affective and sensory pain characteristics through which psychological stress is reduced. The sensory pain dimension must be positively impacted in combination with psychological stress for the bMBI improves women's vitality. Adding a psychosocial intervention like meditation training to the standard treatment plan may be required for some women to achieve the needed changes to restore well-being.
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Affiliation(s)
- Marcelo de França Moreira
- Faculty of Medical Sciences, State University of Rio de Janeiro, Avenida Boulevard 28 de Setembro, 77, Vila Isabel, Rio de Janeiro, RJ, 20551-030, Brazil.
| | - Olga Lucia Gamboa
- EQness, Sydney, Australia
- School of Psychology, A19 - Griffith Taylor Building, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Marco Aurelio Pinho Oliveira
- Department of Gynecology, State University of Rio de Janeiro, Avenida Boulevard 28 de Setembro, 77, Vila Isabel, Rio de Janeiro, RJ, 20551-030, Brazil
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Tourny C, Zouita A, El Kababi S, Feuillet L, Saeidi A, Laher I, Weiss K, Knechtle B, Zouhal H. Endometriosis and physical activity: A narrative review. Int J Gynaecol Obstet 2023; 163:747-756. [PMID: 37345574 DOI: 10.1002/ijgo.14898] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 05/05/2023] [Accepted: 05/16/2023] [Indexed: 06/23/2023]
Abstract
Endometriosis is a painful gynecological disorder that affects many women. Constant treatments and contraception changes affect women looking for solutions to treat and limit the problems caused by endometriosis. The current narrative review discusses the effects of physical activity on the management, pain, and quality of life in patients with endometriosis. Findings suggest that body awareness practices such as Hatha yoga, the Jacobson method, and progressive muscle relaxation reduce pain and stress and improve the quality of life associated with endometriosis. It also highlights the current knowledge gap on available evidence and future research. Moreover, care must be taken when considering patients' physical abilities and goals and avoiding intense physical activities. The forms of endometriosis and its symptoms vary from one woman to another, so it is important to perform studies with various nonmedicinal or surgical techniques. It is important to continue randomized controlled trials to obtain more data on the benefits of physical activity in women with endometriosis and also to identify what types of activities could be beneficial to combat pain symptoms and improve the daily lives of women with endometriosis.
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Affiliation(s)
- Claire Tourny
- Univ Rouen Normandie, CETAPS - UR 3832, Mont Saint Aignan, France
| | - Amira Zouita
- Higher Institute of Sport and Physical Education of Ksar-Said, Research Unit "Sports Performance, Health & Society" (UR17JS01), University of Manouba, Manouba, Tunisia
| | - Samira El Kababi
- High Institute of Nursing Professions and Health Techniques, Casablanca, Morocco
| | - Léa Feuillet
- Univ Rouen Normandie, CETAPS - UR 3832, Mont Saint Aignan, France
| | - Ayoub Saeidi
- Department of Physical Education and Sport Sciences, Faculty of Humanities and Social Sciences, University of Kurdistan, Sanandaj, Kurdistan, Iran
| | - Ismail Laher
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Katja Weiss
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
- Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland
| | - Hassane Zouhal
- Univ Rennes, M2S (Laboratoire Mouvement, Sport, Santé), Rennes, France
- Institut International des Sciences du Sport (2I2S), Irodouer, France
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Núñez-Cortés R, Espin A, Calatayud J, Pérez-Alenda S, Cruz-Montecinos C, López-Bueno R, Vinstrup J, Jakobsen MD, Andersen LL. Can Vitality and Mental Health Influence Upper Extremity Pain? A Prospective Cohort Study of 1185 Female Hospital Nurses. Eur J Investig Health Psychol Educ 2023; 13:2192-2201. [PMID: 37887155 PMCID: PMC10606458 DOI: 10.3390/ejihpe13100154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/28/2023] Open
Abstract
Musculoskeletal disorders of the upper extremity are among the most common occupational problems affecting nurses. The aim of this study was to analyze the prospective association between vitality and mental health and increased upper extremity pain intensity in female hospital nurses during a 1-year follow-up. A prospective cohort of 1185 female nurses from 19 hospitals in Denmark was conducted using baseline and 12-month follow-up questionnaires to identify potential associations between levels of vitality and mental health (SF-36 subscales) with pain intensity (0-10 scale) in the shoulder, elbow and hand/wrist regions. Associations were modeled using cumulative logistic regression. The fully adjusted model included the variables of age, baseline pain, body mass index, smoking status, years of occupation, leisure time physical activity level, number of daily patient transfers/handlings, as well as recognition and influence at work. The mean age was 48.3 (SD: 10.4) years. In the fully adjusted model, significant associations between low vitality levels and the odds of shoulder pain (OR = 1.96; 95%CI: 1.43-2.68) and hand/wrist pain (OR = 2.32; 95%CI: 1.58-3.42) were observed. Likewise, moderate levels of mental health was associated with increased odds of shoulder pain at follow-up (OR = 1.50; 95%CI: 1.16-1.93). These results provide an important incentive for nursing managers to assess vitality and mental health among hospital nurses and to consider this factor in prevention strategies to ensure good worker health and, by extension, high-quality care.
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Affiliation(s)
- Rodrigo Núñez-Cortés
- National Research Centre for the Working Environment, 2100 Copenhagen, Denmark; (R.N.-C.); (A.E.); (R.L.-B.); (J.V.); (M.D.J.); (L.L.A.)
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain;
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8370000, Chile;
| | - Ander Espin
- National Research Centre for the Working Environment, 2100 Copenhagen, Denmark; (R.N.-C.); (A.E.); (R.L.-B.); (J.V.); (M.D.J.); (L.L.A.)
- Ageing on Research Group, Department of Physiology, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain
- Biocruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain
| | - Joaquín Calatayud
- National Research Centre for the Working Environment, 2100 Copenhagen, Denmark; (R.N.-C.); (A.E.); (R.L.-B.); (J.V.); (M.D.J.); (L.L.A.)
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46011 Valencia, Spain
| | - Sofía Pérez-Alenda
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain;
| | - Carlos Cruz-Montecinos
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8370000, Chile;
- Division of Research, Development and Innovation in Kinesiology, Kinesiology Unit, San José Hospital, Santiago 8370000, Chile
| | - Rubén López-Bueno
- National Research Centre for the Working Environment, 2100 Copenhagen, Denmark; (R.N.-C.); (A.E.); (R.L.-B.); (J.V.); (M.D.J.); (L.L.A.)
- Biocruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain
- Department of Physical Medicine and Nursing, University of Zaragoza, 50009 Zaragoza, Spain
| | - Jonas Vinstrup
- National Research Centre for the Working Environment, 2100 Copenhagen, Denmark; (R.N.-C.); (A.E.); (R.L.-B.); (J.V.); (M.D.J.); (L.L.A.)
| | - Markus D. Jakobsen
- National Research Centre for the Working Environment, 2100 Copenhagen, Denmark; (R.N.-C.); (A.E.); (R.L.-B.); (J.V.); (M.D.J.); (L.L.A.)
| | - Lars Louis Andersen
- National Research Centre for the Working Environment, 2100 Copenhagen, Denmark; (R.N.-C.); (A.E.); (R.L.-B.); (J.V.); (M.D.J.); (L.L.A.)
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Samami E, Shahhosseini Z, Khani S, Elyasi F. Pain-focused psychological interventions in women with endometriosis: A systematic review. Neuropsychopharmacol Rep 2023; 43:310-319. [PMID: 37366616 PMCID: PMC10496056 DOI: 10.1002/npr2.12348] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 04/08/2023] [Accepted: 04/30/2023] [Indexed: 06/28/2023] Open
Abstract
AIMS As a chronic inflammatory disease, endometriosis (EMS) is often associated with pain affecting different aspects of women's lives. Up to now, a wide variety of interventions have been implemented to alleviate pain in patients with this condition, including pharmacological, surgical, and rarely non-pharmacological ones. Against this background, this review aimed to investigate pain-focused psychological interventions among EMS women. METHODS A systematic review of the articles published in this field was conducted through a comprehensive search on the databases of Scopus, PubMed, MEDLINE, Web of Science, ScienceDirect, the Cochrane Library, PsycINFO, Google Scholar, and Scientific Information Database (SID). The quality of studies was then assessed by the Jadad Scale. RESULTS In total, 10 articles were entered into this systematic review. The findings further revealed that the pain-focused psychological interventions in patients with EMS were cognitive-behavioral therapy (CBT) (n = 2), mindfulness therapy (n = 4), yoga (n = 2), psychoeducation (n = 1), and progressive muscle relaxation (PMR) training (n = 1). Besides, the findings established that all the given interventions had improved and reduced pain in women living with this condition. Moreover, five articles were of good quality based on the Jadad Scale. CONCLUSION The study results demonstrated that all the listed psychological interventions had affected pain relief and improvement in women suffering from EMS. Considering the limited number of studies in this field and the fact that there were only five articles endowed with good quality, more high-quality studies could provide stronger evidence to support the implementation of the mentioned interventions influencing pain in patients.
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Affiliation(s)
- Elahe Samami
- Student Research CommitteeMazandaran University of Medical SciencesSariIran
| | - Zohreh Shahhosseini
- Sexual and Reproductive Health Research CenterMazandaran University of Medical SciencesSariIran
| | - Soghra Khani
- Sexual and Reproductive Health Research CenterMazandaran University of Medical SciencesSariIran
| | - Forouzan Elyasi
- Psychiatry and Behavioral Sciences Research Center, Sexual and Reproductive Health Research Center, Addiction InstituteMazandaran University of Medical SciencesSariIran
- Department of Psychiatry, Faculty of MedicineMazandaran University of Medical SciencesSariIran
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11
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Stout ME, Keirns BH, Hawkins MAW. Hypocortisolemic reactivity to acute social stress among lonely young women. Soc Neurosci 2023; 18:171-182. [PMID: 37381132 DOI: 10.1080/17470919.2023.2229082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Indexed: 06/30/2023]
Abstract
We examined biopsychosocial stress of acute social pain in relation to chronic loneliness. Hypotheses: 1) Cyberball exclusion (vs. inclusion) would be associated with lower cortisol reactivity to a speech task, and 2) loneliness would moderate the relationship between social exclusion and cortisol reactivity to a speech task, such that higher loneliness would be linked to lower cortisol. Participants (n = 31, women, aged 18-25, 51.6% non-Hispanic white) were randomized to be excluded or included in a game of Cyberball, then completed a speech task. Salivary cortisol was measured at baseline, pre-speech, post-speech, and 15 minutes post-speech. Cortisol reactivity was calculated using area under the curve-increase (AUCi). ANOVA revealed a non-significant, meaningful effect of Cyberball exclusion on cortisol AUCi (p=.103, ηp2=.10), accounting for contraceptive use. Moderation analysis revealed among women with high loneliness, women in the exclusion condition had significantly lower cortisol reactivity than women in the inclusion condition (p=.001). For women with low and medium loneliness, there were no significant differences by Cyberball condition. In sum, lonely young women who are excluded may have hypocortisolemic responses to social stress. Results are consistent with literature suggesting that chronic stress is linked to lower cortisol responses, which is linked to negative physical health outcomes.
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Affiliation(s)
- Madison E Stout
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Bryant H Keirns
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, USA
| | - Misty A W Hawkins
- Department of Health & Wellness Design, Indiana University, Bloomington, IN, USA
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Artacho-Cordón F, Lorenzo Hernando E, Pereira Sánchez A, Quintas-Marquès L. Conceptos actuales en dolor y endometriosis: diagnóstico y manejo del dolor pélvico crónico. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2023. [DOI: 10.1016/j.gine.2023.100843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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Nieves-Vázquez CI, Detrés-Marquéz AC, Torres-Reverón A, Appleyard CB, Llorens-De Jesús AP, Resto IN, López-Rodríguez V, Ramos-Echevarría PM, Castro EM, Flores I. Feasibility and acceptability of an adapted environmental enrichment intervention for endometriosis: A pilot study. Front Glob Womens Health 2023; 3:1058559. [PMID: 36683601 PMCID: PMC9846621 DOI: 10.3389/fgwh.2022.1058559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/28/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction We have previously shown that Environmental Enrichment (EE)-consisting of social support, novelty, and open spaces-decreased disease progression and anxiety in a rat model of endometriosis. We developed a novel EE intervention to be tested in a pilot randomized clinical trial (RCT) in patients with endometriosis, a painful, stressful disease. Objective To translate and evaluate the feasibility and acceptability of an adapted EE intervention as an adjuvant to standard-of-care for endometriosis patients. Methods Feasibility was assessed through recruitment, enrollment, and adherence rates. Acceptability was evaluated through a post-intervention survey and focus group discussion 3-months after the end of the intervention. Results Of the 103 subjects recruited, 64 were randomized to the intervention group and 39 to the control group. At the start of the intervention, the study groups consisted of 29 (intervention) and 27 (control) subjects. Enrollment rates were 45.3% and 69.2%, and adherence rates were 41.4% and 100% for the intervention and control groups, respectively. Delays resulting from natural events (earthquakes, the COVID-19 pandemic) impacted enrollment and adherence rates. The most common reasons for missing an intervention were period pain (39.1%) and work-study (34.8%). There was high acceptability (>80%) of the intervention's logistics. The majority (82.4%) of subjects would continue participating in support groups regularly, and 95.7% would recommend the intervention to other patients. Conclusions We showed that EE could be translated into an acceptable integrative multi-modal therapy perceived as valuable among participants who completed the intervention. High attrition/low adherence indicates that additional refinements would be needed to improve feasibility. Acceptability data indicate that EE has the potential to be integrated into the clinical management of patients with endometriosis and other inflammatory, painful disorders. Studies are ongoing to assess the efficacy of EE in improving pain symptoms, mental health, and quality of life (QoL).
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Affiliation(s)
| | | | - Annelyn Torres-Reverón
- Department of Basic Sciences, Ponce Health Science University, Ponce, Puerto Rico
- Sur180 Therapeutics, LLC, McAllen, TX, United States
| | - Caroline B. Appleyard
- School of Medicine, Ponce Health Sciences University, Ponce, Puerto Rico
- Department of Basic Sciences, Ponce Health Science University, Ponce, Puerto Rico
- Sur180 Therapeutics, LLC, McAllen, TX, United States
| | | | - Ivana N. Resto
- School of Medicine, Ponce Health Sciences University, Ponce, Puerto Rico
| | | | | | - Eida M. Castro
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Idhaliz Flores
- School of Medicine, Ponce Health Sciences University, Ponce, Puerto Rico
- Department of Basic Sciences, Ponce Health Science University, Ponce, Puerto Rico
- Sur180 Therapeutics, LLC, McAllen, TX, United States
- Department of Obstetrics and Gynecology, Ponce Health Sciences University, Ponce, Puerto Rico
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Wu S, Wang X, Liu H, Zheng W. Efficacy of cognitive behavioral therapy after the surgical treatment of women with endometriosis: A preliminary case-control study. Medicine (Baltimore) 2022; 101:e32433. [PMID: 36595829 PMCID: PMC9794269 DOI: 10.1097/md.0000000000032433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Regardless of unique status or symptoms, any woman with endometriosis is at risk of developing mental health issues such as anxiety and depression. Cognitive behavioral therapy (CBT) is an effective psychological treatment for depression, anxiety, and stress. The objectives of the study were to see whether usual care combined with CBT improves depression, anxiety, and stress in patients after surgery for endometriosis as compared to usual care alone. METHODS Patients aged 18 to 50 years old with endometriosis who were scheduled for surgery were received usual care (Chinese martial arts) with CBT (1 pre-surgery and 6 post-surgery CBT sessions; Case or Intervention group, n = 48) or usual care only (Control group, n = 48). The demographic characteristics questionnaire was given to all individuals. Depression, anxiety, and stress were evaluated at baseline (within 24 hours after admission to the hospital) and postintervention (immediately before discharged) in both groups using the Chinese short version of Depression Anxiety and Stress scale (DASS-21). RESULTS At postintervention DASS-21 scores for depression, anxiety, and stress of the case group and the control group were decreased as compared to baseline (P < .0001 for all). At postintervention DASS-21 score for anxiety of the case group was decreased compared to the control group (P = .0091). Usual care plus CBT significantly increased the number of females with no symptoms of depression as compared to baseline at postintervention(s) (P = .0356). At postintervention(s), there was no female with extremely severe depression in both groups. Usual care plus CBT significantly decreased the number of females with symptoms of extremely severe anxiety as compared to baseline at postintervention(s) (P = .035). Unlike the control group, in the case group, there were no females with extremely severe stress at postintervention. CONCLUSIONS females with endometriosis who had surgery reported high levels of depression, anxiety, and stress at the time of hospital admission. Patients with endometriosis can benefit from CBT.
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Affiliation(s)
- Shanshan Wu
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Xia Wang
- Cancer department of traditional Chinese medicine, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu Sichuan, China
| | - Heng Liu
- Department of Obstetrics and Gynecology, the General Hospital of Western Theater Command PLA, Chengdu, Sichuan, China
| | - Wei Zheng
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
- *Correspondence: Wei Zheng, Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, No. 20, Section 3, Renmin South Road, Chengdu, Sichuan 610041, ChinaKey Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, China (e-mail: )
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15
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Kalfas M, Chisari C, Windgassen S. Psychosocial factors associated with pain and health-related quality of life in Endometriosis: A systematic review. Eur J Pain 2022; 26:1827-1848. [PMID: 35802060 PMCID: PMC9543695 DOI: 10.1002/ejp.2006] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 05/26/2022] [Accepted: 07/03/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVE Endometriosis is associated with pain and impaired health-related quality of life (HRQoL). Psychosocial factors have been associated with pain and HRQoL in other conditions, suggesting their potential relevance in Endometriosis. However, the role of psychosocial factors in this population has not been systematically explored yet. This systematic review aims to explore the association of psychosocial factors with pain intensity/severity and HRQoL in women with Endometriosis. DATABASES AND DATA TREATMENT Observational and experimental studies that explored the association of psychosocial factors with pain and HRQoL in women with Endometriosis were eligible. The following databases were searched: Medline, Embase, Cochrane library, Web of Science, PsychInfo and Cumulative index of nursing and allied health literature. The methodological quality was assessed, and findings were synthesized using narrative synthesis. RESULTS Twenty-seven studies were eligible for inclusion, which included 5419 women with Endometriosis. Catastrophising and anxiety were the factors most consistently associated with greater pain, whilst depression, anxiety and stress were related to worse HRQoL. Findings regarding depression and pain were mixed, and research on social factors was limited. CONCLUSIONS This systematic review highlights the role of psychosocial factors in Endometriosis. Anxiety, depression and catastrophising are suggested as potential treatment targets. The review also indicates the lack of research on other potentially important psychosocial factors, such as avoidance, perceived injustice and social support. SIGNIFICANCE This systematic review explored the role of psychosocial factors in Endometriosis, suggesting that these are associated with pain and health-related quality of life (HRQoL). Among the psychosocial factors included, anxiety, depression and catastrophising were the factors most often associated with pain and HRQoL in Endometriosis. These findings highlight the need to target psychological factors in the treatment of women with Endometriosis.
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Affiliation(s)
- Michail Kalfas
- Health Psychology SectionInstitute of Psychiatry, Psychology, and Neuroscience, King's College LondonLondonUK
| | - Claudia Chisari
- Health Psychology SectionInstitute of Psychiatry, Psychology, and Neuroscience, King's College LondonLondonUK
| | - Sula Windgassen
- Health Psychology SectionInstitute of Psychiatry, Psychology, and Neuroscience, King's College LondonLondonUK
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16
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Vannuccini S, Clemenza S, Rossi M, Petraglia F. Hormonal treatments for endometriosis: The endocrine background. Rev Endocr Metab Disord 2022; 23:333-355. [PMID: 34405378 PMCID: PMC9156507 DOI: 10.1007/s11154-021-09666-w] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 12/25/2022]
Abstract
Endometriosis is a benign uterine disorder characterized by menstrual pain and infertility, deeply affecting women's health. It is a chronic disease and requires a long term management. Hormonal drugs are currently the most used for the medical treatment and are based on the endocrine pathogenetic aspects. Estrogen-dependency and progesterone-resistance are the key events which cause the ectopic implantation of endometrial cells, decreasing apoptosis and increasing oxidative stress, inflammation and neuroangiogenesis. Endometriotic cells express AMH, TGF-related growth factors (inhibin, activin, follistatin) CRH and stress related peptides. Endocrine and inflammatory changes explain pain and infertility, and the systemic comorbidities described in these patients, such as autoimmune (thyroiditis, arthritis, allergies), inflammatory (gastrointestinal/urinary diseases) and mental health disorders.The hormonal treatment of endometriosis aims to block of menstruation through an inhibition of hypothalamus-pituitary-ovary axis or by causing a pseudodecidualization with consequent amenorrhea, impairing the progression of endometriotic implants. GnRH agonists and antagonists are effective on endometriosis by acting on pituitary-ovarian function. Progestins are mostly used for long term treatments (dienogest, NETA, MPA) and act on multiple sites of action. Combined oral contraceptives are also used for reducing endometriosis symptoms by inhibiting ovarian function. Clinical trials are currently going on selective progesterone receptor modulators, selective estrogen receptor modulators and aromatase inhibitors. Nowadays, all these hormonal drugs are considered the first-line treatment for women with endometriosis to improve their symptoms, to postpone surgery or to prevent post-surgical disease recurrence. This review aims to provide a comprehensive state-of-the-art on the current and future hormonal treatments for endometriosis, exploring the endocrine background of the disease.
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Affiliation(s)
- Silvia Vannuccini
- Obstetrics and Gynecology, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
| | - Sara Clemenza
- Obstetrics and Gynecology, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
| | - Margherita Rossi
- Obstetrics and Gynecology, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
| | - Felice Petraglia
- Obstetrics and Gynecology, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Florence, Italy.
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Maulitz L, Stickeler E, Stickel S, Habel U, Tchaikovski SN, Chechko N. Endometriosis, psychiatric comorbidities and neuroimaging: Estimating the odds of an endometriosis brain. Front Neuroendocrinol 2022; 65:100988. [PMID: 35202605 DOI: 10.1016/j.yfrne.2022.100988] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 02/07/2022] [Accepted: 02/17/2022] [Indexed: 12/12/2022]
Abstract
Endometriosis is a chronic pain disorder that affects young women, impairing their physical, mental and social well-being. Apart from personal suffering, it imposes a significant economic burden on the healthcare system. We analyzed studies reporting comorbid mental disorders in endometriosis based on the ICD/DSM criteria, discussing them in the context of available neuroimaging studies. We postulate that at least one-third of endometriosis patients suffer from mental disorders (mostly depression or anxiety) and require psychiatric or psychotherapeutic support. According to three neuroimaging studies involving patients with endometriosis, brain regions related not only to pain processing but also to emotion, cognition, self-regulation and reward likely constitute the so-called "endometriosis brain". It is not clear, however, whether the neurobiological changes seen in these patients are caused by chronic pain, mental comorbidities or endometriosis itself. Given the paucity of high-quality data on mental comorbidities and neurobiological correlates in endometriosis, further research is needed.
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Affiliation(s)
- L Maulitz
- Department of Gynaecology and Obstetrics, RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - E Stickeler
- Department of Gynaecology and Obstetrics, RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - S Stickel
- Department of Psychiatry, Psychotherapy and Psychosomatics RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany; Institute of Neuroscience and Medicine: JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Wilhelm-Johnen-Strasse, 52428 Jülich, Germany
| | - U Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany; Institute of Neuroscience and Medicine: JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Wilhelm-Johnen-Strasse, 52428 Jülich, Germany
| | - S N Tchaikovski
- Department of Gynaecology and Obstetrics, RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany; Department of Gynaecology and Obstetrics, Otto von Guericke University Magdeburg, Gerhart-Hauptmann-Straße 35, 39108 Magdeburg, Germany
| | - N Chechko
- Department of Psychiatry, Psychotherapy and Psychosomatics RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany; Institute of Neuroscience and Medicine: JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Wilhelm-Johnen-Strasse, 52428 Jülich, Germany; Institute of Neuroscience and Medicine, Brain & Behavior (INM-7), Research Center Jülich, Wilhelm-Johnen-Strasse, 52428 Jülich, Germany.
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18
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Donatti L, Malvezzi H, Azevedo BCD, Baracat EC, Podgaec S. Cognitive Behavioral Therapy in Endometriosis, Psychological Based Intervention: A Systematic Review. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2022; 44:295-303. [PMID: 35576938 PMCID: PMC9948268 DOI: 10.1055/s-0042-1742406] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 11/16/2021] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION Endometriosis is an inflammatory disease that affects women of reproductive age, causing pain and the possibility of infertility. Endometriosis was associated to low life quality and research shows the impact of endometriosis in several areas of life, justifying how these patients are more likely to develop depression, anxiety, and stress. OBJECTIVE The aim of the present systematic review was to explore the field of psychology in endometriosis, identifying studies that used the cognitive behavioral therapy technique as a treatment for endometriosis and chronic pelvic pain. METHODS The keywords used were Endometriosis and Behavioral Therapy; Behavioral Disciplines and Activities; Cognitive Behavioral Therapy; Mental Health; Psychological Techniques; Psychology; Psychotherapy; Mental Health Services; and the search was performed in the following databases: PubMed/Medline, Scielo, Lilacs, and Capes. The study followed the PRISMA guidelines and all studies whose intervention strategy used was related to cognitive-behavioral therapy were considered. RESULTS Of the 129 articles found, only 5 were selected, and it was possible to identify that the psychological intervention whose approach brought cognitive-behavioral therapy techniques promoted a decrease in the sensation of pain, improvements in the scores of depression and stress, and significant changes in aspects of quality of life such as vitality, physical and social functioning, emotional well-being, control, and autonomy. CONCLUSION Cognitive-behavioral therapy can be very promising to take care of the emotional side of those who have endometriosis However, the present systematic review highlights the need to develop more structured studies with consistent, clear and replicable methods to reach a psychological intervention protocol for patients who live with this gynecological-physical-emotional condition.
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Affiliation(s)
- Lilian Donatti
- Departamento de Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | - Edmund Chada Baracat
- Departamento de Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Sergio Podgaec
- Departamento de Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Appleyard CB, Cruz ML, Velazquez-Cruz J, Rivera-Mendez RM, Jimenez-Garcia JG, Rivera LA, Mendez-Casillas MDM, Flores I, Al-Nakkash L, Chompre G. Voluntary Wheel Running Reduces Vesicle Development in an Endometriosis Animal Model Through Modulation of Immune Parameters. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 3. [PMID: 36284640 PMCID: PMC9580825 DOI: 10.3389/frph.2021.826541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Endometriosis is a chronic gynecological disorder characterized by the growth of endometrial glands and stroma outside the endometrial cavity producing inflammation and pain. Previously we demonstrated that modulation of the hypothalamic pituitary adrenal (HPA) axis exacerbates the development and severity of this condition. A physically active lifestyle has been shown to confer health benefits in many chronic conditions by potentially acting as a stress buffer, thus we hypothesized that voluntary physical exercise can “realign/reset” the HPA axis resulting in reduced endometriosis symptoms in an animal model. Methods Endometriosis was induced in female Sprague Dawley rats by implanting uterine tissue next to the intestinal mesentery on day 0. Sham controls received sutures only. One group of endometriosis animals had access to a running wheel for 2 weeks prior to endometriosis induction until time of sacrifice at day 60. Sham and endometriosis controls received no exercise. All animals were examined for developed vesicles which were collected and measured. Uterine tissue was analyzed for cellular infiltration. Brain, liver, spleen, adrenal glands, leg muscles, and fat were collected, along with peritoneal fluid and blood. Results Endometriosis animals developed vesicles in 86.96% of the implants with significantly increased mesenteric fat compared to sham (p < 0.05). Exposure to exercise significantly decreased the size (p < 0.01) and number (p < 0.05) of vesicles that developed, as well as the mesenteric fat (p < 0.01). Exercised animals had higher levels of lactoferrin in peritoneal fluid, and decreased serum fractalkine and leptin. Exercise significantly increased estrogen alpha receptor expression levels (p < 0.01), while significantly decreasing estrogen receptor beta expression (p < 0.01) and macrophage infiltration (p < 0.05) in vesicles compared to non- exercised animals. Conclusions Our results suggest that voluntary physical activity might protect against endometriosis and alleviate the associated inflammation via immune modulation of the HPA axis. This offers the potential for further exploration of exercise as a complementary therapy in endometriosis patients.
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Affiliation(s)
- Caroline B. Appleyard
- Department of Basic Sciences, Ponce Research Institute, Ponce Health Sciences University-Medical School, Ponce, Puerto Rico
- *Correspondence: Caroline B. Appleyard
| | - Myrella L. Cruz
- Department of Basic Sciences, Ponce Research Institute, Ponce Health Sciences University-Medical School, Ponce, Puerto Rico
| | | | - Raquel M. Rivera-Mendez
- Department of Basic Sciences, Ponce Research Institute, Ponce Health Sciences University-Medical School, Ponce, Puerto Rico
| | - Juan G. Jimenez-Garcia
- Department of Basic Sciences, Ponce Research Institute, Ponce Health Sciences University-Medical School, Ponce, Puerto Rico
| | - Luis A. Rivera
- Department of Basic Sciences, Ponce Research Institute, Ponce Health Sciences University-Medical School, Ponce, Puerto Rico
| | | | - Idhaliz Flores
- Department of Basic Sciences, Ponce Research Institute, Ponce Health Sciences University-Medical School, Ponce, Puerto Rico
| | - Layla Al-Nakkash
- Department of Physiology, Midwestern University, Glendale, AZ, United States
| | - Gladys Chompre
- Department of Basic Sciences, Ponce Research Institute, Ponce Health Sciences University-Medical School, Ponce, Puerto Rico
- Biology Department, Pontifical Catholic University of Puerto Rico, Ponce, Puerto Rico
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20
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Effectiveness of intracavitary monopolar dielectric radiofrequency in women with endometriosis-associated pain: A case series. Complement Ther Clin Pract 2021; 46:101517. [PMID: 34864492 DOI: 10.1016/j.ctcp.2021.101517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 08/04/2021] [Accepted: 11/22/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND and Purpose: Endometriosis-associated pain is the main cause of chronic pelvic pain in women. Endometriosis has a significant negative impact across different domains of patients' quality of life. This study aimed to evaluate the efficacy of an intracavitary application of monopolar dielectric radiofrequency in women with endometriosis-associated pain. PATIENT PRESENTATION Five women with endometriosis received 25 sessions of an intracavitary application of monopolar dielectric radiofrequency within three months. Outcomes, including quality of life, sex interference (Endometriosis Health Profile [EHP]-30 + section C), myofascial pain syndrome (myofascial trigger points), pain intensity (Visual Analogue Scale), frequency and referral pattern, pressure pain thresholds, allodynia and neuropathic pain (modified DN4), were examined both during and outside menses, after intervention and six months later. RESULTS Clinically meaningful improvements were achieved by most participants regarding pelvic pain intensity, abdominal sensitivity, and myofascial pain of the pelvic floor. CONCLUSION This study lays the foundation for future in-depth research, suggesting that monopolar dielectric radiofrequency could be helpful in improving the symptomatology and quality of life of women with endometriosis, also in patients who are unresponsive to medical and/or surgical treatments, or who cannot undergo them in the short term.
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21
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de França Moreira M, Gamboa OL, Pinho Oliveira MA. Association between severity of pain, perceived stress and vagally-mediated heart rate variability in women with endometriosis. Women Health 2021; 61:937-946. [PMID: 34719338 DOI: 10.1080/03630242.2021.1993423] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Chronic pelvic pain is the main symptom in women with endometriosis. Evidence suggests that psychological stress and autonomic regulation contribute to symptoms and pathophysiological modulation. We investigated the relationship between endometriosis-related pain severity, perceived stress, and autonomic balance in a sample of 81 women suffering chronic pelvic pain with deep endometriosis. Perceived stress and pelvic pain symptoms were assessed using the 10-item version of the Perceived Stress Scale (PSS-10) and the Numeric Pain Rating Scale (NPRS), respectively. Autonomic nervous system regulation was evaluated using vagally mediated components of the heart rate variability (vmHRV). Our results showed that pain unpleasantness and perceived stress were positively correlated, and women with mood disorders had higher perceived stress. The women with low resting vmHRV experience more intense pelvic pain, pain unpleasantness, and a higher number of severe endometriosis-related pain descriptors. The positive association between perceived stress, mood disorder, and pain unpleasantness demonstrates the additive effect between these aversive experiences. The inverse association between parasympathetic tone and pain suggests contributions of the Descending Inhibitory Pain pathway efficiency to symptom severity in women with endometriosis.
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Affiliation(s)
| | - Olga Lucia Gamboa
- EQness, Sydney, New South Wales, Australia.,School of Psychology, University of Sydney, Camperdown, New South Wales, Australia
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22
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Tennfjord MK, Gabrielsen R, Tellum T. Effect of physical activity and exercise on endometriosis-associated symptoms: a systematic review. BMC WOMENS HEALTH 2021; 21:355. [PMID: 34627209 PMCID: PMC8502311 DOI: 10.1186/s12905-021-01500-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/27/2021] [Indexed: 11/17/2022]
Abstract
Background Endometriosis is a common benign gynecological disease that has the potential to debilitate due to pain and reduced quality of life. Treatment modalities such as hormones and surgery have limitations and do not treat all dimensions of the problems caused by endometriosis, and physical activity (PA) and exercise have been suggested as alternative treatments. Aim of this study was to perform a systematic review and meta-analysis to assess the effect of PA and exercise on endometriosis-associated symptoms.
Methods Eleven databases were searched systematically. Study selection, quality assessment, and data extraction were carried out by two independent researchers in accordance with PRISMA guidelines. Eligibility criteria were women with diagnosed endometriosis receiving an intervention (PA and/or exercise). The primary outcome was pain intensity, but all outcomes were accepted. Results This study screened 1045 citations for eligibility. Four interventional studies were identified, of which one showed fatal design flaws and so was excluded. Three studies, two randomized controlled trials (RCT) and one pre-post study with no control group, involving 109 patients were included in a descriptive synthesis. The interventions included flexibility and strength training, cardiovascular fitness, and yoga, and were performed from one to four times per week for a total duration of 8–24 weeks, with or without supervision. Only one study found improvements in pain intensity. One study showed decreases in stress levels. Due to the heterogeneity of the study outcomes and measures, as well as confounding factors, a quantitative meta-analysis could not be performed. Conclusion The effect of PA and exercise as treatments for endometrioses-associated symptoms could not be determined due to significant limitations of the included studies. Future research should be based on RCTs of high methodological quality, measuring and reporting relevant core outcomes such as pain, improvements in symptoms and quality of life, and acceptability and satisfaction from the perspectives of patients. Furthermore, these outcomes need to be measured using reliable and validated tools. Trial registration number CRD42021233138. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01500-4.
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Affiliation(s)
| | - Rakel Gabrielsen
- Department of Obstetrics and Gynecology, Akershus University Hospital, Sykehusveien 25, 1478, Nordbyhagen, Norway.,Tollbugata Fysioterapi, Tollbugata 13, 3044, Drammen, Norway
| | - Tina Tellum
- Department of Gynecology, Oslo University Hospital, PB 0424, 0459, Nydalen, Oslo, Norway
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23
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Hansen S, Sverrisdóttir UÁ, Rudnicki M. Impact of exercise on pain perception in women with endometriosis: A systematic review. Acta Obstet Gynecol Scand 2021; 100:1595-1601. [PMID: 33999412 DOI: 10.1111/aogs.14169] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/16/2021] [Accepted: 05/07/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Endometriosis is challenging to treat. It is a painful and chronic inflammatory disorder that impacts up to 10% of women of reproductive age. Despite available surgical and medical treatment options, recurrence of symptoms is common. Available studies suggest that exercise may have a therapeutic effect on chronic inflammation and thereby on pain perception. This review evaluates whether exercise can decrease pain perception in women with symptomatic endometriosis. MATERIAL AND METHODS This systematic review was conducted according to PRISMA by searching databases Medline and Embase to locate randomized controlled trials and observational studies. Risk of bias was investigated using the Cochrane Collaboration Tool for the Evaluation of Randomized Controlled Trials and the ROBINS-I quality assessment scale. Inclusion criteria were women of reproductive age, laparoscopically confirmed diagnosis of endometriosis, and intervention of any type of exercise. All manuscripts were evaluated by two of the authors and when in doubt a third author was consulted. This review was registered in PROSPERO on November 14, 2020 (CRD42020212309). RESULTS Six articles fulfilled the inclusion criteria and were included in this systematic review. Concerning exercise, two studies showed significant decrease in pain relief but the remaining studies showed either negative or no impact on pain relief. A meta-analysis could not be conducted because of the considerable heterogeneity among the included studies. CONCLUSIONS The present review does not indicate any beneficial effect of exercise on pain in women with endometriosis. There is a need for randomized controlled trials with correct power calculation, well-defined study groups and training programs to be able to answer the question of whether exercise can improve the pain experience in patients with endometriosis.
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Affiliation(s)
- Sara Hansen
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | | | - Martin Rudnicki
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
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Casalechi M, Vieira-Lopes M, Quessada MP, Arão TC, Reis FM. Endometriosis and related pelvic pain: association with stress, anxiety and depressive symptoms. Minerva Obstet Gynecol 2021; 73:283-289. [PMID: 34008383 DOI: 10.23736/s2724-606x.21.04704-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Endometriosis is a chronic inflammatory disease affecting 10% of women in reproductive age and manifested as infertility and pelvic pain, which may be severe and incapacitating. This review aims to address the latest evidence on the association of endometriosis with chronic stress, anxiety and depression, and to find out whether the effective treatment of endometriosis has the additional benefit of attenuating these psychological comorbidities. Studies have found that women with endometriosis, especially those with painful symptoms, have higher levels of stress and a decreased quality of life compared to healthy women. Importantly, depression and anxiety are more prevalent in women with endometriosis, and the presence of psychiatric disorders correlates more to the severity of the endometriosis-related pain than to other disease characteristics. Considering therapeutic implications, controlled clinical trials found that medical and surgical treatments of endometriosis also ameliorated perceived stress, anxiety and depressive symptoms. In conclusion, current evidence indicates that women with endometriosis have an increased prevalence of psychological disorders which correlate more with pain itself than with endometriosis per se. In addition, the effective treatment of endometriosis may reduce the psychological burden of the disease.
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Carbone MG, Campo G, Papaleo E, Marazziti D, Maremmani I. The Importance of a Multi-Disciplinary Approach to the Endometriotic Patients: The Relationship between Endometriosis and Psychic Vulnerability. J Clin Med 2021; 10:jcm10081616. [PMID: 33920306 PMCID: PMC8069439 DOI: 10.3390/jcm10081616] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/04/2021] [Accepted: 04/06/2021] [Indexed: 12/24/2022] Open
Abstract
Endometriosis is a chronic inflammatory condition, which is distinguished by the presence of the endometrial-like glands and stroma outside the uterine cavity. Pain and infertility are the most commonly expressed symptoms, occurring in 60% and 40% of cases, respectively. Women with endometriosis, especially those with pelvic pain, also have a greater vulnerability to several psychiatric disorders. There is, in particular, a tendency to contract affective or anxiety disorders as well as panic-agoraphobic and substance use disorders. Endometriosis with pelvic pain, infertility and psychic vulnerability usually leads to disability and a markedly lower quality of life for women of reproductive age. Thus, the burden of endometriosis is not limited to the symptoms and dysfunctions of the disease; it extends to the social, working and emotional spheres, leading to a severe impairment of global functioning. An analysis of scientific literature revealed a close relationship between specific temperamental traits, the expression of several psychiatric symptoms, chronicity of pain, risk of substance use and lower probability of a positive outcome. Endometriosis symptoms and the impact of related psychological consequences, increased vulnerability and the possible onset of psychiatric symptoms may influence coping strategies and weaken resilience, so triggering a vicious cycle leading to a marked deterioration in the quality of life. A multidisciplinary approach consisting of a medical team composed of gynecologists, psychologists, psychiatrists, experts in Dual Disorder, algologists and sexologists, would guarantee the setting of a target and taking the best decision on a personalized treatment plan. That approach would allow the prompt detection of any psychopathological symptoms and improve the endometriosis-related physical symptoms, bringing a healthier quality of life and a greater likelihood of a positive outcome.
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Affiliation(s)
- Manuel Glauco Carbone
- PISA-School of Experimental and Clinical Psychiatry, 56100 Pisa, Italy;
- Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, 21100 Varese, Italy
| | - Giovanni Campo
- Obstetrics and Gynecology Department, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.C.); (E.P.)
| | - Enrico Papaleo
- Obstetrics and Gynecology Department, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.C.); (E.P.)
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Donatella Marazziti
- 1st Psychiatric Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy;
- Saint Camillus International University of Health and Medical Sciences-UniCamillus, 00131 Rome, Italy
| | - Icro Maremmani
- Saint Camillus International University of Health and Medical Sciences-UniCamillus, 00131 Rome, Italy
- Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), 55045 Pietrasanta, Lucca, Italy
- Vincent P. Dole Dual Disorder Unit, 2nd Psychiatric Unit, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy
- G. De Lisio Institute of Behavioral Sciences, 56100 Pisa, Italy
- Correspondence: ; Tel.: +39-050-993045
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Hypothalamic-Pituitary-Adrenal Axis Responses in Women with Endometriosis-Related Chronic Pelvic Pain. Reprod Sci 2020; 27:1839-1847. [PMID: 32572832 DOI: 10.1007/s43032-020-00201-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/01/2020] [Indexed: 12/13/2022]
Abstract
Some chronic pain conditions and comorbidities suppress the hypothalamic-pituitary-adrenal (HPA) axis and response to dynamic testing. We measured HPA axis responses to corticotropin-releasing hormone (CRH) administration in relation to chronic pelvic pain and endometriosis. In a cross-sectional study of women (n = 54) with endometriosis-associated chronic pelvic pain (n = 22), chronic pelvic pain alone (n = 12), or healthy volunteers (n = 20), adrenocorticotropic-releasing hormone (ACTH) and cortisol levels were measured at 0, 15, 30, and 45 min after intravenous ovine CRH administration. ACTH and cortisol delta (peak-baseline) and area under the curve (AUC) were compared by study group and assessed for association with race and menstrual and non-menstrual pain severity. HPA axis responses did not differ among the racially diverse groups or in those with pain compared with healthy volunteers. However, when stratified by race, ACTH delta (129.9 ± 130.7 vs. 52.5 ± 66.0 pg/mL; p = 0.003), ACTH AUC (4813 ± 4707 vs. 2290 ± 2900 min*pg/mL; p = 0.013), and cortisol delta (26.3 ± 21.5 vs. 13.2 ± 9.7 μg/mL; p = 0.005) were significantly higher in black (n = 10) than predominately white (non-black) subjects (n = 44; 39/44 white). In analyses among primarily white (non-black) women, greater menstrual pain severity was associated with blunted ACTH delta (p = 0.015) and cortisol delta (p = 0.023), and greater non-menstrual pain severity with blunted cortisol delta (p = 0.017). Neuroendocrine abnormalities in women with chronic pelvic pain may differ by pain manifestations and may vary by race. The higher HPA axis response in black women merits investigation in pelvic pain studies stratified by race. In white (non-black) women experiencing pain, a blunted response was related to pain severity suggesting pain affects women independently of endometriosis lesions.
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Brooks T, Sharp R, Evans S, Baranoff J, Esterman A. Predictors of Psychological Outcomes and the Effectiveness and Experience of Psychological Interventions for Adult Women with Chronic Pelvic Pain: A Scoping Review. J Pain Res 2020; 13:1081-1102. [PMID: 32547173 PMCID: PMC7247613 DOI: 10.2147/jpr.s245723] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 03/24/2020] [Indexed: 11/23/2022] Open
Abstract
Objective CPP affects approximately 15% of women worldwide and has significant psychological, physical and financial impact on the lives of sufferers. Psychological interventions are often recommended as adjuncts to medical treatment for women with chronic pelvic pain (CPP). This is as women with CPP experience higher rates of mental health concerns and difficulties coping with their pain.. However, recent systematic reviews have highlighted that the efficacy of psychological interventions is not conclusive in this population. This review aimed to identify predictors of mental health outcomes and effective psychological techniques and interventions in women with CPP to inform the development of future psychological therapies. Methods Scoping review using the method outlined by Arskey & O'Malley (2005). Relevant databases, reference lists and grey literature were searched to identify effective mental health interventions and predictors of psychological outcomes for women with CPP. Results Methodological concerns made identifying predictors of mental health outcomes and effective psychological interventions difficult. However, cognitive behavioural therapy and Mensendieck therapy emerged as therapeutic interventions with the best evidence for women with CPP. A number of useful predictors of mental health outcomes and techniques included in effective interventions were identified. Conclusion The evidence provided in this review has the potential to inform future research directions and the development of targeted psychological interventions for women with CPP.
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Affiliation(s)
- Tiffany Brooks
- The University of South Australia, School of Nursing and Midwifery, Adelaide, South Australia, Australia.,Aware Women's Health Private Clinic, Adelaide, South Australia, Australia
| | - Rebecca Sharp
- The University of South Australia, School of Nursing and Midwifery, Adelaide, South Australia, Australia
| | - Susan Evans
- University of Adelaide, Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia
| | - John Baranoff
- University of Adelaide, Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia.,Centre for Treatment of Anxiety and Depression, Adelaide, South Australia, Australia
| | - Adrian Esterman
- The University of South Australia, School of Nursing and Midwifery, Adelaide, South Australia, Australia.,James Cook University, Health and Medicine, Cairns, Queensland, Australia
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Appleyard CB, Flores I, Torres-Reverón A. The Link Between Stress and Endometriosis: from Animal Models to the Clinical Scenario. Reprod Sci 2020; 27:1675-1686. [PMID: 32542543 DOI: 10.1007/s43032-020-00205-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/08/2020] [Indexed: 12/18/2022]
Abstract
There is strong evidence from humans and animal models showing that abnormal functioning of the hypothalamic-pituitary-adrenal (HPA) axis and/or the inflammatory response system disrupts feedback regulation of both neuroendocrine and immune systems, contributing to disease. Stress is known to affect the physiology of pelvic organs and to disturb the HPA axis leading to chronic, painful, inflammatory disorders. A link between stress and disease has already been documented for many chronic conditions. Endometriosis is a complex chronic gynecological disease associated with severe pelvic pain and infertility that affects 10% of reproductive-aged women. Patients report the negative impact of endometriosis symptoms on quality of life, work/study productivity, and personal relationships, which in turn cause high levels of psychological and emotional distress. The relationship between stress and endometriosis is not clear. Still, we have recently demonstrated that stress increases the size and severity of the lesions as well as inflammatory parameters in an animal model. Furthermore, the "controllability" of stress influences the pathophysiology in this model, offering the possibility of using stress management techniques in patients. The crosstalk between stress-inflammation-pain through HPA axis activity indicates that stress relief should alleviate inflammation and, in turn, decrease painful responses. This opens up the opportunity of altering brain-body-brain pathways as potential new therapeutic option for endometriosis. The goal of this review is to gather the research evidence regarding the interaction between stress (psychological and physiological) and the development and progression of endometriosis on the exacerbation of its symptoms with the purpose of proposing new lines of emerging research and possible treatment modalities for this still incurable disease.
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Affiliation(s)
- Caroline B Appleyard
- Department of Basic Sciences, Women's Health Division, Ponce Research Institute, Ponce Health Sciences University, Ponce, PR, USA. .,Department of Internal Medicine, Ponce Health Sciences University, Ponce, PR, USA. .,Department of Basic Sciences, Physiology Division, Medical School and Ponce Research Institute, Ponce Health Sciences University, 395 Zona Ind Reparada 2, Ponce, PR, 00716-2347, USA.
| | - Idhaliz Flores
- Department of Basic Sciences, Women's Health Division, Ponce Research Institute, Ponce Health Sciences University, Ponce, PR, USA.,Department of Obstetrics and Gynecology, Ponce Health Sciences University, Ponce, PR, USA
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Vrekoussis T, Siafaka V, Tsitou A, Tsonis O, Navrozoglou I, Makrigiannakis A, Paschopoulos M. Endometriosis-related chronic pelvic pain: A mini review on pathophysiology and impact on mental health. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2020. [DOI: 10.1177/2284026519895829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Endometriosis-related chronic pelvic pain is a major component of the disease that affects quality of life in women of reproductive age suffering from endometriosis. The present review summarizes current evidence upon pathophysiology and its impact on mental health. It seems that endometriosis-related chronic pelvic pain is the result of chronic stress on the central nervous system as a consequence of chronic pelvic inflammation. Mental health issues may rise as a result of central nervous system derangement and further aggravate pain perception and therefore quality of life. Further properly designed studies are needed in order to elucidate the connection between mental disorders and endometriosis-related chronic pelvic pain.
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Affiliation(s)
- Thomas Vrekoussis
- Department of Obstetrics and Gynecology, School of Medicine, University of Crete, Heraklion, Greece
| | - Vassiliki Siafaka
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Alexandra Tsitou
- Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Orestis Tsonis
- Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Iordanis Navrozoglou
- Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Antonis Makrigiannakis
- Department of Obstetrics and Gynecology, School of Medicine, University of Crete, Heraklion, Greece
| | - Minas Paschopoulos
- Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Reis FM, Coutinho LM, Vannuccini S, Luisi S, Petraglia F. Is Stress a Cause or a Consequence of Endometriosis? Reprod Sci 2020; 27:39-45. [PMID: 32046437 DOI: 10.1007/s43032-019-00053-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 06/05/2019] [Indexed: 12/18/2022]
Abstract
Clinical studies clearly indicate that endometriosis is a condition associated with high levels of chronic stress. The stress intensity correlates with pain severity and disease extension. However, it is unknown whether chronic stress represents a primary cause of endometriosis and, therefore, if avoiding or treating chronic stress may reduce the risk of developing endometriosis. Repeated, uncontrolled stress either before or after experimental endometriosis induction promotes disease mechanisms and accelerates lesion growth in rodents. Furthermore, patients with endometriosis have a heightened risk of other inflammatory and immune-related diseases, many of which have also been associated with stress. Here, we review the latest evidences regarding the relationship between chronic stress and endometriosis and discuss the potential bidirectional aspect of such association. Further research may clarify if endometriosis is a cause and/or a consequence of stress and whether stress-reducing therapies are effective to mitigate symptoms and slow down the development of endometriotic lesions.
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Affiliation(s)
- Fernando M Reis
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Larissa M Coutinho
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Department of Maternal and Child Health, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Silvia Vannuccini
- Department of Neuroscience, Psychology, Pharmacology and Child Health (NEUROFARBA), University of Florence, Careggi University Hospital, Largo G. Alessandro Brambilla, 3, 50134, Florence, FI, Italy.,Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University Hospital of Siena, Siena, Italy
| | - Stefano Luisi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University Hospital of Siena, Siena, Italy
| | - Felice Petraglia
- Department of Experimental, Clinical and Biomedical Sciences, Obstetrics and Gynecology, University of Florence, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
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Brasil DL, Montagna E, Trevisan CM, La Rosa VL, Laganà AS, Barbosa CP, Bianco B, Zaia V. Psychological stress levels in women with endometriosis: systematic review and meta-analysis of observational studies. Minerva Med 2019; 111:90-102. [PMID: 31755674 DOI: 10.23736/s0026-4806.19.06350-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Endometriosis is defined as the presence of endometrial-like tissue outside the uterus, associated with chronic and inflammatory reaction. Symptoms range from dysmenorrhea, dyspareunia, chronic pelvic pain, unexplained infertility to asymptomatic. The patients' quality of life is affected by anxiety, depression and stress. We aimed to verify the prevalence and levels of psychological stress among women with endometriosis. EVIDENCE ACQUISITION The systematic review followed the PRISMA statement and the MOOSE guideline. Databases searched were MEDLINE, EMBASE, PsychNET and SciELO. The risk of bias was assessed with a modified Newcastle-Ottawa Scale. The meta-analysis of proportions used inverse variance method for pooling and random-effects model. For the stress levels we used the restricted maximum likelihood estimator for summary effects. Heterogeneity was assessed through I2 and Q statistics. Publication bias was assessed through funnel plots. Meta-regression adopted a mixed-effects model, considering patient age, endometriosis staging, stress assessment tool and data collection as categorical moderators. EVIDENCE SYNTHESIS We included 15 studies encompassing 4,619 women with endometriosis. The overall prevalence of mild/high stress was 68% (95%CI:57%-79%), I2=98% and τ2=0.0228. The mean level of stress was 41.78% (95%CI =34.05%-49.51%), I2=99.9% and τ2=83.35. Meta-regression showed relationship with endometriosis staging. CONCLUSIONS This is the first meta-analysis exploring the association between endometriosis and psychological stress. The interdisciplinary management of the disease should expand the mental health support in this patient care, beyond pain management. Finally, the attitude of the medical team acknowledging the patients' psychological stress may positively affect their treatment.
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Affiliation(s)
- Diogo L Brasil
- Facultade de Medicine do ABC/Centro Universitário Saúde ABC, Santo André, Brazil
| | - Erik Montagna
- Facultade de Medicine do ABC/Centro Universitário Saúde ABC, Santo André, Brazil -
| | - Camila M Trevisan
- Facultade de Medicine do ABC/Centro Universitário Saúde ABC, Santo André, Brazil
| | - Valentina L La Rosa
- Unit of Psychodiagnostics and Clinical Psychology, University of Catania, Catania, Italy
| | - Antonio S Laganà
- Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Caio P Barbosa
- Facultade de Medicine do ABC/Centro Universitário Saúde ABC, Santo André, Brazil.,Discipline of Sexual and Reproductive Health and Populational Genetics, Department of Collective Health, Faculdade de Medicina do ABC/Centro Universitário Saúde ABC, Santo André, Brazil
| | - Bianca Bianco
- Facultade de Medicine do ABC/Centro Universitário Saúde ABC, Santo André, Brazil.,Discipline of Sexual and Reproductive Health and Populational Genetics, Department of Collective Health, Faculdade de Medicina do ABC/Centro Universitário Saúde ABC, Santo André, Brazil
| | - Victor Zaia
- Facultade de Medicine do ABC/Centro Universitário Saúde ABC, Santo André, Brazil.,Discipline of Sexual and Reproductive Health and Populational Genetics, Department of Collective Health, Faculdade de Medicina do ABC/Centro Universitário Saúde ABC, Santo André, Brazil
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La Rosa VL, De Franciscis P, Barra F, Schiattarella A, Török P, Shah M, Karaman E, Marques Cerentini T, Di Guardo F, Gullo G, Ponta M, Ferrero S. Quality of life in women with endometriosis: a narrative overview. Minerva Med 2019; 111:68-78. [PMID: 31755667 DOI: 10.23736/s0026-4806.19.06298-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Endometriosis is a very complex condition and has a significant impact on the quality of life, psychological wellbeing and interpersonal relationships of affected women. Endometriosis symptoms progressively impair the woman's ability to carry out some daily activities and result in a perception of worsening health status and overall well-being. The impact of these symptoms has been only partially investigated, and further studies and clinical insights are needed to fully understand the extent of this condition. It has been shown that endometriosis is associated with considerable direct and indirect costs, comparable to those of major worldwide chronic diseases such as diabetes. In addition, endometriosis-related symptoms substantially interfere with the employment of affected women, resulting in many cases in several working days missed. In this scenario, the aim of this narrative review is to provide a general overview of the psychological and social impact of this disease, as well as the effects of different therapeutic options, on quality of life and general well-being.
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Affiliation(s)
- Valentina L La Rosa
- Unit of Psychodiagnostics and Clinical Psychology, University of Catania, Catania, Italy -
| | - Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Fabio Barra
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy.,Academic Unit of Obstetrics and Gynecology, San Martino University Hospital IRCCS, Genoa, Italy
| | - Antonio Schiattarella
- Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Péter Török
- Faculty of Medicine, Institute of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
| | - Mohsin Shah
- Department of Physiology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Erbil Karaman
- Department of Obstetrics and Gynecology, Yuzuncu Yıl University, Van, Turkey
| | | | - Federica Di Guardo
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Giuseppe Gullo
- AOOR Villa Sofia Cervello, IVF Public Center, Palermo, Italy
| | - Marco Ponta
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Simone Ferrero
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy.,Academic Unit of Obstetrics and Gynecology, San Martino University Hospital IRCCS, Genoa, Italy
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Psychological and mind-body interventions for endometriosis: A systematic review. J Psychosom Res 2019; 124:109756. [PMID: 31443810 DOI: 10.1016/j.jpsychores.2019.109756] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 12/23/2022]
Abstract
Endometriosis is a common gynecological condition associated with debilitaing pain and poor mental health. This review examines the evidence for psychological and mind-body (PMB) interventions to improve endometriosis pain, psychological distress, sleep and fatigue. Electronic databases searched included PsychINFO, MEDLINE, CINAHL, EMBASE, Cochrane Library, Scopus, and PubMed. Inclusion criteria were women with endometriosis, and interventions that used psychological or mind-body interventions; there were no exclusion criteria regarding study design. Studies were identified and coded using standard criteria, and risk of bias was assessed with established tools relevant to the study design. A total of 12 publications relating to 9 separate studies were identified:- 3 randomized controlled trials, 1 controlled trial, 2 single-arm studies, 1 retrospective cohort study, and 2 case series. Interventions included yoga, mindfulness, relaxation training, cognitive behavioural therapy combined with physical therapy, Chinese medicine combined with psychotherapy, and biofeedback. Results indicate that no studies have yet used gold-standard methodology and, thus, definitive conclusions cannot be offered about PMB efficacy. However, the results of these pilot studies suggest that PMB interventions show promise in alleviating pain, anxiety, depression, stress and fatigue in women with endometriosis, and future well-designed RCTs including active control groups are warranted.
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Bourdel N, Chauvet P, Billone V, Douridas G, Fauconnier A, Gerbaud L, Canis M. Systematic review of quality of life measures in patients with endometriosis. PLoS One 2019; 14:e0208464. [PMID: 30629598 PMCID: PMC6328109 DOI: 10.1371/journal.pone.0208464] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/16/2018] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Endometriosis and quality of life has been the subject of much research, however, there is little consensus on how best to evaluate quality of life in endometriosis, resulting in many and diverse scales being used. In our study, we aim to identify quality of life scales used in endometriosis, to review their strengths and weaknesses and to establish what would define an ideal scale in the evaluation of endometriosis-related quality of life. MATERIALS AND METHODS A search of the MEDLINE and EMBASE databases was carried out for publications in English and French for the period from 1980 to February 2017, using the words 'endometriosis' and 'quality of life'. Publications were selected if they reported on quality of life in patients with endometriosis and specified use of a quality of life scale. A quantitative and a qualitative analysis of each scale was performed in order to establish the strengths and weaknesses for each scale (systematic registration number: PROSPERO 2014: CRD42014014210). RESULTS A total of 1538 articles publications were initially identified. After exclusion of duplicates and application of inclusion criteria, 201 studies were selected for analysis. The SF-36, a generic HRQoL measure, was found to be the most frequently used scale, followed by the EHP-30, a measure specific to endometriosis. Both perform well, when compared with other scales, with scale weaknesses offset by strengths. EHP-5 and EQ-5D also showed to be of good quality. All four were the only scales to report on MCID studied in endometriosis patients. CONCLUSION For clinical practice, routine evaluation of HRQOL in women with endometriosis is essential both for health-care providers and patients. Both SF-36 and EHP-30 perform better overall with regard to their strengths and weaknesses when compared to other scales.
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Affiliation(s)
- Nicolas Bourdel
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- Faculty of Medecine, ISIT-University of Auvergne, Clermont-Ferrand, France
| | - Pauline Chauvet
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- Faculty of Medecine, ISIT-University of Auvergne, Clermont-Ferrand, France
| | - Valentina Billone
- Department of Mother and Child, University Hospital P. Giaccone, Palermo, Italy
| | - Giannis Douridas
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Arnaud Fauconnier
- Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Poissy, EA 7285 Research Unit ‘Risk and Safety in Clinical Medicine for Women and Perinatal Health’, Versailles-Saint-Quentin University (UVSQ), Montigny-le-Bretonneux, France
| | - Laurent Gerbaud
- Dept of Public Health, PEPRADE, Université Clermont Auvergne, CHU Clermont-Ferrand, France, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Michel Canis
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- Faculty of Medecine, ISIT-University of Auvergne, Clermont-Ferrand, France
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Mira TA, Buen MM, Borges MG, Yela DA, Benetti-Pinto CL. Systematic review and meta-analysis of complementary treatments for women with symptomatic endometriosis. Int J Gynaecol Obstet 2018; 143:2-9. [DOI: 10.1002/ijgo.12576] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/05/2018] [Accepted: 06/25/2018] [Indexed: 01/20/2023]
Affiliation(s)
- Ticiana A.A. Mira
- Department of Obstetrics and Gynecology; School of Medical Sciences; University of Campinas; Campinas Brazil
| | - Mariana M. Buen
- Department of Obstetrics and Gynecology; School of Medical Sciences; University of Campinas; Campinas Brazil
| | - Murilo G. Borges
- Department of Medical Genetics; School of Medical Sciences; University of Campinas; Campinas Brazil
| | - Daniela A. Yela
- Department of Obstetrics and Gynecology; School of Medical Sciences; University of Campinas; Campinas Brazil
| | - Cristina L. Benetti-Pinto
- Department of Obstetrics and Gynecology; School of Medical Sciences; University of Campinas; Campinas Brazil
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Pérez-López FR, Martínez-Domínguez SJ, Viñas A, Pérez-Tambo R, Lafita A, Lajusticia H, Chedraui P. Endometriosis and gestational diabetes mellitus risk: a systematic review and meta-analysis. Gynecol Endocrinol 2018; 34:363-369. [PMID: 29105527 DOI: 10.1080/09513590.2017.1397115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To perform a systematic review and meta-analysis regarding endometriosis and the risk of gestational diabetes mellitus (GDM). METHODS We carried out a search of the following databases: Medline, Embase, Web of Science, Cochrane Library, Scopus, Scielo, Clinicaltrials.gov, the UK Clinical Trials Gateway, and the Australian New Zealand Clinical Trials Registry, from inception through April 28 2017, without language restrictions, in order to evaluate the effect of endometriosis over GDM risk, in women with and without endometriosis. Odds ratios (ORs) and their 95% confidence intervals (CIs) or mean differences (MDs) were calculated as effects. Methodological quality of evidence was assessed with the Newcastle-Ottawa Scale, and heterogeneity among studies with the I2 statistic. Random-effects models were used for meta-analyses, and publication bias was assessed with Egger's test. RESULTS We identified 12 studies (10 cohort and two case control studies) with a total of 48,762 pregnancies, including 3,461 with endometriosis. Endometriosis had no significant effect on GDM risk (OR =1.14; 95% CI: 0.86, 1.51; p = .35, I2 = 56%, Egger's test p = .45). Secondary outcomes (gestational age at delivery, birthweight, and Neonatal Intensive Care Unit admission) were statistically similar in women with and without endometriosis. CONCLUSIONS Better-designed studies are needed to confirm our results.
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Affiliation(s)
- Faustino R Pérez-López
- a Facultad de Medicina , Universidad de Zaragoza & Instituto Aragonés de Ciencias de la Salud (IACS) , Zaragoza , Spain
- b Department of Obstetrics and Gynecology , Lozano-Blesa University Hospital , Zaragoza , Spain
| | - Samuel J Martínez-Domínguez
- a Facultad de Medicina , Universidad de Zaragoza & Instituto Aragonés de Ciencias de la Salud (IACS) , Zaragoza , Spain
| | - Andrea Viñas
- a Facultad de Medicina , Universidad de Zaragoza & Instituto Aragonés de Ciencias de la Salud (IACS) , Zaragoza , Spain
| | - Raquel Pérez-Tambo
- a Facultad de Medicina , Universidad de Zaragoza & Instituto Aragonés de Ciencias de la Salud (IACS) , Zaragoza , Spain
| | - Alberto Lafita
- a Facultad de Medicina , Universidad de Zaragoza & Instituto Aragonés de Ciencias de la Salud (IACS) , Zaragoza , Spain
| | - Héctor Lajusticia
- a Facultad de Medicina , Universidad de Zaragoza & Instituto Aragonés de Ciencias de la Salud (IACS) , Zaragoza , Spain
| | - Peter Chedraui
- c Facultad de Ciencias Médicas , Institute of Biomedicine, Research Area for Women's Health, Universidad Católica de Santiago de Guayaquil , Guayaquil , Ecuador
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van Aken M, Oosterman J, van Rijn T, Ferdek M, Ruigt G, Kozicz T, Braat D, Peeters A, Nap A. Hair cortisol and the relationship with chronic pain and quality of life in endometriosis patients. Psychoneuroendocrinology 2018; 89:216-222. [PMID: 29414035 DOI: 10.1016/j.psyneuen.2018.01.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 12/15/2017] [Accepted: 01/02/2018] [Indexed: 12/30/2022]
Abstract
Endometriosis is a chronic estrogen-dependent disease in which pelvic pain is the dominant symptom. The negative effects of endometriosis on the life of women with this disease can be a cause of stress. Stress levels can be measured in different ways, mostly reflecting acute stress responses. Hair cortisol measurements are a reflection of long-term systematic cortisol levels. In this study a first attempt is made to measure cortisol levels in hair of endometriosis patients in comparison with healthy controls. Moreover, it is explored whether chronic pain symptoms as well as different aspects of Health Related Quality of Life (HRQoL) are associated with hair cortisol levels in women with endometriosis. Results show that the mean hair cortisol level is significantly higher in women with endometriosis compared to healthy controls (p = 0.018). There is a positive correlation between hair cortisol level and HRQoL in patients but not in controls (Rho 0.426). The level of hair cortisol does not correlate with the reported pain intensity in patients (Rho -0.082). These results are indicative of an altered HPA-axis function in endometriosis patients, possibly caused by higher chronic stress level in these patients. Moreover, a potential explanation for the positive correlation of cortisol with the HRQoL in these patients is that patients with a high HRQoL have an adequate stress response by increasing their cortisol levels as a response to physical and emotional stress induced by the endometriosis.
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Affiliation(s)
- Mieke van Aken
- Department of Anatomy, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Gynaecology and Obstetrics, Rijnstate, Arnhem, The Netherlands.
| | - Joukje Oosterman
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Tineke van Rijn
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Magdalena Ferdek
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Psychology Laboratory, Institute of Psychology, Jagiellonian University, Krakow, Poland
| | - Gé Ruigt
- Clinical Consultancy for Neuroscience Drug Development BV, Oss, The Netherlands
| | - Tamas Kozicz
- Department of Anatomy, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Didi Braat
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre Nijmegen, The Netherlands
| | - Ard Peeters
- Department of Anatomy, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Annemiek Nap
- Department of Gynaecology and Obstetrics, Rijnstate, Arnhem, The Netherlands
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Donatti L, Ramos DG, Andres MDP, Passman LJ, Podgaec S. Patients with endometriosis using positive coping strategies have less depression, stress and pelvic pain. EINSTEIN-SAO PAULO 2017; 15:65-70. [PMID: 28444092 PMCID: PMC5433310 DOI: 10.1590/s1679-45082017ao3911] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 01/28/2017] [Indexed: 03/01/2023] Open
Abstract
Objective To determine the correlations between coping strategies, depression, stress levels and pain perception in patients with endometriosis. Methods This prospective and exploratory study included 171 women undergoing treatment for endometriosis between April and August 2014. The questionnaires used were Brief COPE, Beck Depression Inventory, Lipp’s Stress Symptom Inventory for Adults and Visual Analogue Scale. Clinical data were collected from electronic medical records. Results Patients with endometriosis who used positive coping strategies had better adaptation to stress (p<0.004) and less depression (p<0.004). The presence and intensity of depression, stress and acyclic pelvic pain were directly associated (p<0.05). The intensity of dysmenorrhea was associated with the degree of depression (p<0.001), whereas acyclic pelvic pain was associated with the degree of depression (p<0.001), stress level (p<0.001) and stress type (p<0.001). Conclusion We found a positive association between coping, depression levels, type and levels of stress and pain intensity in patients with endometriosis. The use of maladaptive coping strategies focused on emotion is correlated with increase in depression and stress.
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Affiliation(s)
- Lilian Donatti
- Pontifícia Universidade Católica de São Paulo, São Paulo, SP, Brazil
| | | | - Marina de Paula Andres
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Sérgio Podgaec
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.,Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Miller-Matero LR, Saulino C, Clark S, Bugenski M, Eshelman A, Eisenstein D. When treating the pain is not enough: a multidisciplinary approach for chronic pelvic pain. Arch Womens Ment Health 2016; 19:349-54. [PMID: 25941014 DOI: 10.1007/s00737-015-0537-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 04/22/2015] [Indexed: 11/28/2022]
Abstract
Chronic pelvic pain (CPP) is related to psychological distress and interference in daily activities; however, CPP is not as extensively researched as other forms of chronic pain. Therefore, the purpose of this study was to investigate the relationships among pain, psychological distress, and functional impairment in patients with CPP. There were chart reviews conducted of 107 female patients who completed a psychiatric evaluation at a specialty, CPP clinic as a part of a multidisciplinary evaluation. Results suggest that psychological distress and impairment in daily activities are common in CPP patients. Most areas of functional impairment were not associated with pain variables. Rather, several forms of functional impairment were related to higher levels of depression and anxiety. Results from this study suggest the possibility that psychiatric symptoms are contributing to functional impairment in this population. These findings highlight the importance of a multidisciplinary approach in the evaluation and treatment of CPP patients to help decrease functional impairment in these patients.
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Affiliation(s)
| | | | - Shannon Clark
- Behavioral Health, Henry Ford Health System, Detroit, MI, USA
| | - Mary Bugenski
- Behavioral Health, Henry Ford Health System, Detroit, MI, USA
| | - Anne Eshelman
- Behavioral Health, Henry Ford Health System, Detroit, MI, USA
| | - David Eisenstein
- Obstetrics & Gynecology, Henry Ford Health System, Detroit, MI, USA
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A Systematic Review of the Association Between Psychiatric Disturbances and Endometriosis. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:1006-15. [DOI: 10.1016/s1701-2163(16)30050-0] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Quiñones M, Urrutia R, Torres-Reverón A, Vincent K, Flores I. Anxiety, coping skills and hypothalamus-pituitary-adrenal (HPA) axis in patients with endometriosis. ACTA ACUST UNITED AC 2015; 3. [PMID: 26900480 PMCID: PMC4755521 DOI: 10.7243/2054-0841-3-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background Endometriosis is an inflammatory disease that is defined by growth of endometrial tissue outside the uterus, resulting in pain, infertility, and emotional distress. Previous studies have shown that the HPA axis is compromised in patients with chronic, painful diseases, including endometriosis. However, the underlying mechanisms and the physiological and emotional consequences of dysfunctions in the HPA axis in these patients are largely unknown. We aimed to understand whether diurnal circulating cortisol levels in women with endometriosis are affected and how this impacts their emotional and behavioral responses. Methods Thirty-two patients with endometriosis and 36 healthy control women provided saliva samples and completed a series of psychological questionnaires. Salivary cortisol levels were measured in duplicate using a colorimetric immunoassay. Results There were significant differences in average cortisol levels between endometriosis patients and controls. A negative correlation was found between cortisol levels and infertility and dyspareunia. Furthermore, incapacitating pain was found to be a strong predictor of hypocortisolism. Women with endometriosis reported higher levels of trait anxiety, but showed no differences in perceived stress or in coping styles compared to the control group. Conclusions This study supports previous reports of hypocortisolism as a biomarker of aberrant HPA responses in women with endometriosis. Moreover, it provides further insight into the link between HPA axis dysregulation, emotional responses, and the high comorbidity between endometriosis and other inflammatory conditions.
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Affiliation(s)
- Maria Quiñones
- Department of Psychology, Ponce Health Sciences University, Ponce Research Institute, Puerto Rico, USA
| | - Rebecca Urrutia
- Department of Biology, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Annelyn Torres-Reverón
- Department of Psychology, Ponce Health Sciences University, Ponce Research Institute, Puerto Rico, USA.; Department of Physiology, Ponce Health Sciences University, Ponce Research Institute, Puerto Rico, USA
| | - Katy Vincent
- Nuffield Department of Obstetrics and Gynecology, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Idhaliz Flores
- Department of Microbiology, Ponce Health Sciences University, Ponce Research Institute, Puerto Rico, USA
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Appleyard CB, Cruz ML, Hernández S, Thompson KJ, Bayona M, Flores I. Stress management affects outcomes in the pathophysiology of an endometriosis model. Reprod Sci 2015; 22:431-41. [PMID: 25015902 PMCID: PMC4812689 DOI: 10.1177/1933719114542022] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We have previously shown detrimental effects of stress in an animal model of endometriosis. We now investigated whether the ability to control stress can affect disease parameters. Endometriosis was surgically induced in female Sprague-Dawley rats before exposing animals to a controllable (submerged platform) or uncontrollable (no platform) swim stress protocol. Corticosterone levels and fecal pellet numbers were measured as an indicator of stress. Uncontrollable stress increased the number and size of the endometriotic cysts. Rats receiving uncontrollable stress had higher anxiety than those exposed to controllable stress or no stress and higher corticosterone levels. Uncontrollable stressed rats had more colonic damage and uterine cell infiltration compared to no stress, while controllable stress rats showed less of an effect. Uncontrollable stress also increased both colonic and uterine motility. In summary, the level of stress controllability appears to modulate the behavior and pathophysiology of endometriosis and offers evidence for evaluating therapeutic interventions.
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Affiliation(s)
- Caroline B Appleyard
- Department of Physiology and Pharmacology, Ponce School of Medicine and Health Sciences, Ponce, PR, USA
| | - Myrella L Cruz
- Department of Physiology and Pharmacology, Ponce School of Medicine and Health Sciences, Ponce, PR, USA
| | - Siomara Hernández
- Department of Physiology and Pharmacology, Ponce School of Medicine and Health Sciences, Ponce, PR, USA
| | - Kenira J Thompson
- Department of Physiology and Pharmacology, Ponce School of Medicine and Health Sciences, Ponce, PR, USA
| | - Manuel Bayona
- Public Health Program, Ponce School of Medicine and Health Sciences, Ponce, PR, USA
| | - Idhaliz Flores
- Department of Microbiology, Ponce School of Medicine and Health Sciences, Ponce, PR, USA
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Lazzeri L, Orlandini C, Vannuccini S, Pinzauti S, Tosti C, Zupi E, Nappi RE, Petraglia F. Endometriosis and perceived stress: impact of surgical and medical treatment. Gynecol Obstet Invest 2015; 79:229-33. [PMID: 25591624 DOI: 10.1159/000368776] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 10/01/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of the study was to investigate the levels of perceived stress in a group of women with a long-term history of endometriosis in conjunction with surgical and/or medical treatments. METHODS A clinical trial was conducted at the Department of Molecular and Developmental Medicine, University of Siena, in collaboration with a non-profit association of women with endometriosis, A.P.E. Onlus. Patients (n = 204) with a previous diagnosis of endometriosis (for at least 3 years) were included in this study. Each patient completed a semi-structured questionnaire and a validated scale to assess perceived stress, the Perceived Stress Scale (PSS) by e-mail. RESULTS The study showed that in women with a long-term history of endometriosis, the level of perceived stress was increased by repeated surgical treatments and reduced by some medical treatments. The median PSS value was 23 (range 9-36) and 30.6% of the study population were included in the highest stress category (>26). The highest levels were found in patients who had undergone the most surgery. The use of progestins was associated with a lower perceived stress (p = 0.004) than in the patients treated with gonadotropin-releasing hormones. CONCLUSIONS Long-term endometriosis has a relevant impact on perceived stress, in particular in those undergoing repeated surgery.
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Affiliation(s)
- Lucia Lazzeri
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
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Posadzka E, Jach R, Pityński K, Jablonski MJ. Treatment efficacy for pain complaints in women with endometriosis of the lesser pelvis after laparoscopic electroablation vs. CO2 laser ablation. Lasers Med Sci 2015; 30:147-52. [PMID: 25053520 PMCID: PMC4289154 DOI: 10.1007/s10103-014-1630-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 07/03/2014] [Indexed: 01/02/2023]
Abstract
Endometriosis is a chronic disease affecting mainly women of the reproductive age. Its most common manifestations include impaired fecundity, pelvic pain, and dyschezia. Laparoscopic removal of endometriotic foci remains to be the gold standard for the treatment of endometriosis. More effective techniques of endoscopic approach-among others, laser application-are continually being developed. The aim of the study was to evaluate the efficacy of laparoscopic treatment with the use of CO2 laser ablation vs. electroablation with regard to pain complaints in the affected patients. The study included 48 women (aged 22-42) with varying degrees of endometriosis of the lesser pelvis. The Numeric Rating Scale (NRS) was used to evaluate pain intensity before the surgery in all patients, followed by either laser ablation or electroablation of the endometriotic foci. The results of the laparoscopic treatment were monitored after 3 and 6 months postoperatively. p value of 0.05 was considered to be statistically significant. Patients from both groups reported less intensive pain before/during menstruation (dysmenorrhea) 6 months postoperatively, with more distinct tendency in the electroablation group (p = 0.004) as compared to the laser ablation group (p = 0.025). Despite the initial improvement reported at the 3-month checkup (p = 0.008), 6 months postoperatively, a statistically significant increase in pain intensity was noted in both groups (p = 0.016 and p = 0.032 for CO2 laser ablation and electroablation, respectively). Both surgical methods seem to be effective only in the treatment of endometriosis-related dysmenorrhea, whereas the intensity of other pain complaints (dyspareunia, dysuria, dyschezia, pelvic pain syndrome (PPS)) has remained on the same level.
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Affiliation(s)
- Ewa Posadzka
- Departament of Gynecology and Obstetrics, Jagiellonian University Medical College, 23 Kopernika str, 31-501 Krakow, Poland
| | - Robert Jach
- Departament of Gynecology and Obstetrics, Jagiellonian University Medical College, 23 Kopernika str, 31-501 Krakow, Poland
| | - Kazimierz Pityński
- Departament of Gynecology and Obstetrics, Jagiellonian University Medical College, 23 Kopernika str, 31-501 Krakow, Poland
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Bourdel N, Alves J, Pickering G, Ramilo I, Roman H, Canis M. Systematic review of endometriosis pain assessment: how to choose a scale? Hum Reprod Update 2014; 21:136-52. [PMID: 25180023 DOI: 10.1093/humupd/dmu046] [Citation(s) in RCA: 211] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Numerous studies concerning endometriosis and pain have been reported. However, there is no consensus on the best method to evaluate pain in endometriosis and many scales have been used. Moreover, there are only a few descriptions of minimal clinically important differences after treatment (MCID) to evaluate variations in pain. In our study, we aim to identify pain scales used in endometriosis pain treatment, to address their strong and weak points and to define which would be the ideal scale to help clinicians and researchers to evaluate endometriosis-related pain. METHODS A search of the MEDLINE and EMBASE databases was carried out for publications in English, French or Portuguese from 1980 to December 2012, for the words: endometriosis, treatment, pain. Studies were selected if they studied an endometriosis treatment and a pain scale was specified. A quantitative and a qualitative analysis of each scale was performed to define strong and weak points of each scale (systematic registration number: CRD42013005336). RESULTS A total of 736 publications were identified. After excluding duplications and applying inclusion criteria 258 studies remained. We found that the visual analog scale (VAS) is the most frequently used scale. Both VAS and the numerical rating scale (NRS) show a good balance between strong and weak points in comparison with others such as the Biberoglu and Behrman scale. Concerning MCID, only VAS, NRS and Brief Pain Inventory scales have reported MCID and, among these, only VAS MCID has been studied in endometriosis patients (VAS MCID = 10 mm). Adding the Clinical Global Impression score (CGI) to the pain scale allows calculation of the MCID. CONCLUSIONS When using pain scales their strengths and weaknesses must be known and included in the analysis. VAS is the most frequently used pain scale and, together with NRS, seems the best adapted for endometriosis pain measurement. The use of VAS or NRS for each type of typical pain related to endometriosis (dysmenorrhea, deep dyspareunia and non-menstrual chronic pelvic pain), combined with the CGI and a quality-of-life scale will provide both clinicians and researchers with tools to evaluate treatment response.
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Affiliation(s)
- Nicolas Bourdel
- Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, 63058 Clermont Ferrand Cedex 1, France Faculté de medicine, ISIT - Université d'Auvergne, Place Henri Dunant, 63000 Clermont-Ferrand, France
| | - João Alves
- Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, 63058 Clermont Ferrand Cedex 1, France
| | - Gisele Pickering
- Centre de Pharmacologie Clinique, CHU Clermont Ferrand, Inserm CIC 501, Inserm, U1107 Neuro-Dol, F-63003 Clermont-Ferrand, France
| | - Irina Ramilo
- Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, 63058 Clermont Ferrand Cedex 1, France
| | - Horace Roman
- Department of Gynecology and Obstetrics, Rouen University Hospital-Charles Nicolle, 1 rue de Germont, 76031 Rouen, France
| | - Michel Canis
- Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, 63058 Clermont Ferrand Cedex 1, France Faculté de medicine, ISIT - Université d'Auvergne, Place Henri Dunant, 63000 Clermont-Ferrand, France
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Endometriosis patients in the postmenopausal period: pre- and postmenopausal factors influencing postmenopausal health. BIOMED RESEARCH INTERNATIONAL 2014; 2014:746705. [PMID: 24987703 PMCID: PMC4058668 DOI: 10.1155/2014/746705] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 05/20/2014] [Indexed: 11/30/2022]
Abstract
Objective. To evaluate patients' health status and the course of endometriosis from the premenopausal to the postmenopausal period and evaluate influencing factors that may be relevant. Methods. Questionnaire completed by 35 postmenopausal women in whom endometriosis had been histologically confirmed premenopausally. Correlation and regression analyses were carried out to identify factors relevant to their postmenopausal health status. Results. Overall, there was clear improvement in typical endometriosis symptoms and sexual life. Clear associations (P < 0.005) were observed between premenopausal factors like physical limitations caused by the disease, impaired social contacts and psychological problems, and postmenopausal pain and impairment of sexual life. Three statistical models for assessing pain and impairment of sexual life in the postmenopausal period were calculated on the basis of clinical symptoms in the premenopausal period, with a very high degree of accuracy (P < 0.001; R2 = 0.833/0.857/0.931). Conclusions. The results of the survey strongly suggest that physical fitness and freedom from physical restrictions, a good social environment, and psychological care in both the premenopausal and postmenopausal periods lead to marked improvements in the postmenopausal period with regard to pain, dyspareunia, and influence on sexual life in endometriosis patients.
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