Trauma, Mood, and Pain: A Mediated Relationship in Endometriosis

Half of Women With Endometriosis Report Trauma, and Its Effect on Pain Is Psychologically Mediated

Key Points

Highlights: 

• Trauma exposure is common among women with endometriosis, and its impact on pain operates indirectly through psychological factors.

Importance:

• Understanding how trauma influences pain through psychological pathways may lead to more effective, multidimensional pain management strategies.
• Addressing depression, anxiety, and catastrophizing may reduce pain severity and improve quality of life in women with endometriosis.

What's Done Here?

• This is a cross-sectional study conducted in an endometriosis outpatient referral center.
• Clinical, socio-demographic, trauma exposure, and psychological measures (depression, anxiety, post-traumatic stress, pain catastrophizing) were collected using validated questionnaires during gynecologic evaluation.
• A total of 120 women with clinical or histologic endometriosis participated (76.9% response rate).

Key Results:

• Nearly 50% of participants had clinically significant depression or anxiety.
• Around 25% experienced substantial post-traumatic stress symptoms or high pain catastrophizing.
• Approximately half reported one or more traumatic events.
• Trauma did not directly correlate with pain intensity.
• Depression and pain catastrophizing significantly mediated the association between trauma exposure and increased pain levels.

Strengths and Limitations:

• Strengths are, the use of validated psychological assessment tools and examination of multiple emotional mediators within the same cohort.
• Limitations are, the cross-sectional design, reliance on self-reported trauma and symptoms, and recruitment from a single specialized center, limiting broader generalizability. 

From the Editor-in-Chief – EndoNews

"Pain in endometriosis is complex and often far more severe than what is visible on imaging or laparoscopy. This study offers important insight into why this mismatch occurs by examining how past trauma and current emotional health may interact with the body’s pain-processing pathways. Crucially, the study does not suggest that pain is psychological or imagined—rather, it highlights how the nervous system can become more sensitive after difficult life experiences, making pain feel stronger and more persistent.

The finding that depressive symptoms and certain pain-related thoughts help explain the link between trauma and higher pain intensity reinforces what chronic pain science has shown for years: emotional wellbeing and physical pain are tightly interconnected through shared biological pathways. Addressing emotional burdens is therefore not about questioning the reality of pain—it is about offering patients more tools to help reduce suffering.

Importantly, the study encourages clinicians to adopt a more comprehensive, compassionate approach. When trauma, mood symptoms, or overwhelming worry about pain are present, supportive interventions—whether psychological, medical, or integrative—may help lower pain intensity and improve overall quality of life. This is not a replacement for medical treatment; it is an extension of care that acknowledges the full experience of living with endometriosis.

While the study's cross-sectional design limits conclusions about causality, its message is clear: effective endometriosis care must combine biological, emotional, and social understanding. Recognizing the whole person allows us to treat pain more effectively and respectfully, validating the lived reality of patients who have long described the depth and complexity of their symptoms."

Lay Summary

Women living with endometriosis often experience chronic pelvic pain, but the reasons why some women report more severe pain than others are not fully understood.

Trauma has been linked to altered pain perception in other chronic pain conditions, yet its specific role in endometriosis has rarely been examined.

In a study conducted at an endometriosis referral center named Città della Salute e della Scienza di Torino University Hospital at Turin, Italy, researchers surveyed 120 women about their trauma history, emotional wellbeing, and pain symptoms. Many participants reported elevated levels of depression, anxiety, post-traumatic stress, or pain catastrophizing—patterns consistent with the psychological burden often observed in endometriosis.

About half had experienced at least one traumatic event.

Interestingly, trauma did not directly predict how much pain a woman reported. Instead, the study found that trauma influenced pain indirectly through two psychological factors: depression and pain catastrophizing (a tendency to magnify or feel helpless about pain). These emotional responses acted as bridges between trauma exposure and heightened pain perception.

The findings highlight that pain in endometriosis is shaped not only by biological factors but also by psychological and emotional experiences.

Recognizing and addressing depression, anxiety, trauma-related symptoms, and pain catastrophizing may therefore help improve pain management and overall quality of life for women with endometriosis.

Research Source: https://pubmed.ncbi.nlm.nih.gov/41021895/