Thesis Title: Biopsychosocial Assessment of Endometriosis-Associated Pain

Women (18-49 years) with and without Endometriosis are assessed for the biological and psychosocial
contributors to chronic pelvic pain.
The biological aspects are assessed with neuro-psychophysical testing. The aim is to build a
somatosensory profile detailing the changes in sensory function in women with and without
endometriosis.
The psychophysical aspects are assessed with self-reported instruments. These questionnaires detail the
physical, emotional, cognitive and self-belief contributions to pain severity in women with and without
endometriosis.
The women with endometriosis are further assessed for the influence their emotions, cognitions and
self-belief have on the functional abnormalities observed in their somatosensory profile and the
severity of their pain.

Chapter 7 Results: Psychosocial aspects of Chronic Endometriosis-Associated Pain
This study only focusses on women; 15-49 years, suffering from chronic pelvic pain associated with
endometriosis; may also experience dysmenorrhea (painful periods).
Please include studies that investigated the bio-psychosocial aspects of chronic pain in relation to
the points outlined above; namely female and pelvic pain.
Please include references from last 5 years to keep it contemporary.
More references than provided here will be required.
Thank you.
Section 7A and 7B; need 5 pages in total, please;
Needs to be a story line that runs through all the section and sub-sections, even though they each
focus on a different aspect of the story:
The overall story is that chronic pain is the result of the dynamic contribution of biological and
psychosocial factors. Modulation of the psychosocial factors can influence the biological factors.
Those with better psychosocial functioning have less pain severity.

Note: biological contributors: underlying disease, general physical functioning, activity interference
Psychosocial contributors: emotional, psychological and cognitive behaviour
Section 7A Chronic Pain and Emotion; need 2.5 pages in total for this section; including the sub-
sections, below
Chronic pain is often accompanied by psychological and emotional distress.
Wesselmann U et al 1998; Uterine inflammation as a noxious visceral stimulus: behavioural
characterization in the rat
Anxiety; need 0.75 page
Finding from this study:
Women with endometriosis experience anxiety levels similar to those age-matched individuals
experiencing chronic pain and higher than the non-endometriosis women and general population.
References should reflect this finding.
Keogh E and Mansoor L 2001; Investigating the effects of anxiety sensitivity and coping on the
perception of cold pressor pain in healthy women
McCracken LM and Gross RT 1998; The role of pain-related anxiety reduction in the outcome of
multidisciplinary treatment for low back pain
Boersma K and Linton SJ 2006; Psychological processes underlying the development of a chronic pain
problem
Depression; need 0.75 page
Finding from this study:
Women with endometriosis experience depression at a similar severity as a chronic pain population and
higher than the non-endometriosis women and general population.
References should reflect this finding.
Von Korff M and Simon G 1996; The relationship between pain and depression
Stress; need 0.75 page
Finding from this study:
Women with endometriosis experience stress at a similar severity as a chronic pain population and
higher than the non-endometriosis women and general population.

Section7B: Chronic Pain, Cognitions and Beliefs; need 2.5 pages in total
Includes: Self-belief, active coping skills and catastrophising thoughts
Finding from this study:
The younger EEs (21-30 years) reported their belief in being able to carry on with their life despite
the pain as similar to the equivalently-aged chronic pain population. Yet, additional age (31-40 years)
appeared to significantly increase women’s belief that they could cope with their pain as compared with
their age-matched chronic pain counterparts.
Women with endometriosis experienced catastrophising thoughts equal to the chronic pain population.
Moreover, the younger women (21-30 years) with endometriosis employed about the same level of active
coping thoughts as those with chronic pain. Yet, the older women with endometriosis (31-40 years), in
spite of their catastrophising thoughts, employed significantly higher levels of coping cognitions,
compared with the general chronic pain population.
Overall, those with better self-belief and active coping thoughts experience less pain and have greater
engagement with all aspects of their life.

References should reflect this finding.
Please include references from the last 5 years.
Sharp TJ 2001; Chronic pain: a reformulation of the cognitive-behavourial model

Smeets RJE et al 2006; Reduction of pain catastrophising mediated the outcome of both physical and
cognitive-behavioral treatment of chronic low back pain
Severeijns, Vlaeyen and ven den Hout 2004; Do we need a communal coping model of pain catastrophising?
An alternative explanation

Buchbinder R and Jolley D 2005; Effects of a media campaign on back beliefs is sustained 3 years after
its cessation

Self-efficacy: one can perform a task or produce a desirable outcome (Bandura 1977)
Bandura A 1977; Self-efficacy: toward a unifying theory of behavioral change
Perceived control over the pain:
Samwel, Evers Crul and Kraaimaat 2006; The role of helplessness, fear of pain and pain-coping in
chronic pain patients
Turner JA et al 2000; Do beliefs, coping and catastrophising independently predict functioning in
patients with chronic pain?
Jensen MP et al 2001; Changes in beliefs, catastrophising and coping are associated with improvement in
multidisciplinary pain treatment
deCharms RC et al 2005; Control over brain activation and pain learned by using real-time functional
MRI

Asghari A and Nicholas M 2001; Pain Self-Efficacy Beliefs and pain behaviour: a prospective study
Woby SR et al 2005; Coping strategy use: does it predict adjustment to chronic back pain after
controlling for catastrophic thinking and self-efficacy for pain control?
Keefe FJ et al 2004; Psychological aspects of persistent pain: current state of the science
Koenig Alex et al 2014; Biopsychosocial functioning and pain self-efficacy in chonic low back pain
patients
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