Quels facteurs psychologiques faut-il identifier dans la prise en charge des patients souffrant de lombalgies ? Qu’en est-il de l’anxiété et de la dépression ? Quelles peurs et quelles représentations constituent-elles des écueils ?

Endometriosis diagnosis buffers reciprocal effects of emotional distress on pain experience

OBJECTIVES

Emotional profile is involved in the experience of chronic pain related to endometriosis. Following the Örebro Model of Behavioral Emotion Regulation of Pain, the aim of this study was to understand the processes involved in the psychological adaptation to pain experienced during menstruations in women either diagnosed or not diagnosed with endometriosis.

METHODS

The study was conducted on a sample of 545 women, either diagnosed with endometriosis or not, during their menstruations. Functional repercussions and intensity of pain, catastrophic thinking, difficulties in emotional regulation and emotional distress were assessed through an online questionnaire. Structural equation modeling (SEM) was carried out.

RESULTS

Women diagnosed with endometriosis experience more suffering than women who have not had such a diagnosis. The model we adapted from Örebro's model fits the data well. A differential effect is observed regarding the retroactive effect of depression on pain. Although emotional distress increases functional repercussions among women both with and without the diagnosis, growing pain intensity only occurs among those without.

CONCLUSIONS

A woman presenting pain during menstruation faces emotional regulation issues that make her more vulnerable to the development of emotional distress. Pain impacts emotional distress, but emotional distress does not impact pain among women for whom the origin of the pain was known (i.e., a diagnosis of endometriosis). Having a diagnosis allows women to externalize the origin of their pain, attributing it to the disease and not to their psychological state.

Chronic low back pain and the transdiagnostic process: How do cognitive and emotional dysregulations contribute to the intensity of risk factors and pain?

Background and aims

Based on a transdiagnostic approach, this study assesses the impact of cognitive and emotional processes (difficulties in emotional regulation, impulsiveness, rumination and somatosensory amplification) on the psychological risk factors of chronic low-back pain.

Methods

The study was carried out with 256 patients with chronic low-back pain. All the variables were assessed through a booklet of 10 validated questionnaires. Multiple regression analysis and moderation analysis were performed.

Results

Predictors included in multiple regression models explain 3%-42% (adjusted R 2) of the variance in psychological risk factors. Moreover, analyses reveal a significant moderator effect of somatosensory amplification on the link between fear-avoidance beliefs linked to work and pain intensity (F (3;250) = 12.33; p = .00), of somatosensory amplification and brooding on the link between depression and functional repercussions (FR) on everyday life (F (3;252) = 13.36; p = .000; F (1;252) = 12.42; p = .00), of the reflection dimension of rumination on the link between the helplessness dimension of catastrophizing and FRs on sociability (F (3;252) = 37.02; p = .00). There is also a moderation analysis with a significant trend concerning the lack of emotional awareness and the difficulties in controlling impulsive behaviours.

Conclusions

Our results indicate an important role of some dimensions of difficulties in emotional regulation, somatosensory amplification and rumination in the increase in negative affects and dysfunctional beliefs, and in the links between those psychological risk factors and pain/disability.

Implications

This study identifies some cognitive and emotional dysregulations substantially involved in work-related chronic pain. This contribute to put in place psychotherapeutic protocols to tackle these deficits and dysregulations in a relevant way.