Abstract
INTRODUCTION: Endometriosis causes severe and chronic pain leading to impaired Health-Related Quality of Life (HRQoL). While endometriosis surgery does improve pain intensity, psychological factors have an important role in pain perception. The current study aims to evaluate the independent contribution of pain catastrophizing and anxiety and depression to HRQoL between six months and nine years following endometriosis surgery. METHODS: This is a cross-sectional questionnaire study including women with endometriosis who were surgically treated for endometriosis-related pain. Hierarchical multiple linear regression analysis was used to evaluate the relationship of pain catastrophizing and a total score for anxiety and depression to HRQoL, in addition to the contributions of pain intensity, fatigue and sleep quality. In a sub-analysis, we evaluated this relationship in patients with a shorter and with a longer time since surgery (TSS). RESULTS: The study included 195 participants, revealing significant correlations between HRQoL, pain catastrophizing and anxiety and depression. Subgroup analysis demonstrated that both pain catastrophizing and a combined anxiety and depression score significantly predicted HRQoL in both the shorter and longer TSS groups. These associations were found in addition to the contribution of pain intensity, fatigue and sleep quality to HRQoL. CONCLUSION: The current study demonstrates that pain catastrophizing and a combination of anxiety and depression contribute to HRQoL in patients six months to nine years after surgical treatment of endometriosis. Extended post-surgical care could be warranted to address these factors accordingly, for example with psychological care, in addition to surgery alone.