A biopsychosocial perspective on endometriosis: the importance of psychological inflexibility, 2026, Åkerblom et al.

[SNT Gatchaman]

A biopsychosocial perspective on endometriosis: the importance of psychological inflexibility

Spoiler: Authors

Åkerblom, Sophia; Peppler Jönsson, Ingrid; Ringqvist, Åsa; Nordengren, Johanna; Zhao, Xiang

INTRODUCTION
Treatment strategies for endometriosis have traditionally been biomedical. There is a need for a more multidimensional understanding of endometriosis and more targeted and individualized treatment interventions, including psychological approaches.

METHODS
The aims of this study were twofold: (1) to identify key biopsychosocial characteristics in individuals attending a tertiary clinic for endometriosis and (2) to inform the development of future, targeted, and efficacious interventions by examining the importance of psychological processes central to two scientific models, pain catastrophizing and fear of movement from the fear-avoidance model, and psychological inflexibility from the psychological flexibility model.

RESULTS
Psychosocial variables, more specifically perceived control and powerlessness, social support, and depression, were of particular importance to the symptom structure in this patient population. In contrast, biological factors appeared to have low relevance within this network. When aiming to inform the development of future, promising psychological interventions for endometriosis, psychological inflexibility emerged as the most important psychological process variable in the symptom network.

CONCLUSIONS
A multidimensional approach based on the biopsychosocial model appears valuable for understanding endometriosis. Treatment interventions grounded in the psychological flexibility model may hold promise for this patient population, a possibility that warrants further investigation in future studies.

Web | DOI | PDF | Archives of Gynecology and Obstetrics | Open Access

 

[SNT Gatchaman]

Due to ethical restrictions the research data supporting the results of the manuscript cannot be shared.

 

[SNT Gatchaman]

Endometriosis is an inflammatory disease in which endometrial-like tissue grows outside the uterus, affecting an estimated 10% of women worldwide. Characteristic symptoms include painful menstruation, ovulation, intercourse, and defecation; urinary tract and gastrointestinal symptoms; and fertility problems. A significant proportion of individuals with endometriosis experience chronic pelvic pain, and pain is widely recognized as a cardinal symptom of the condition.

The symptoms of endometriosis are complex, heterogeneous, and multidimensional, pointing to the fact that the symptom profiles might be better understood from a biopsychosocial viewpoint, where the dynamic interplay of biological, psychological, and social factors is considered together.

Evidence-based treatment programs for chronic pain are grounded in the biopsychosocial model and commonly use psychological principles, most often cognitive behavioral therapy (CBT). CBT has proven to be effective for chronic pain and might be a promising candidate for improved quality of life in endometriosis. The fear-avoidance model is a focused CBT model centered on chronic pain. Kinesiophobia or fear of movement, and catastrophizing are core concepts within this long-established and active scientific model. The psychological flexibility model, which also stems from the CBT tradition, has gained increasing empirical support in the chronic pain field over the past decade.

Kinesiophobia, pain catastrophizing, and psychological (in) flexibility have been established as key treatment mechanisms in interventions for chronic pain and have gained some attention in endometriosis.

The only psychological inflexibility appears to be team BPS.

 

[ScoutB]

Psychosocial variables [...] were of particular importance to the symptom structure in this patient population. In contrast, biological factors appeared to have low relevance within this network.

Biological factors, by the way, were determined via this system:

Pain intensity was measured with the Numerical Rating Scale (NRS). The NRS is well-established and is used in pain research to measure pain intensity over the past week on an 11-point scale (0=no pain; 10=worst possible pain). [...] Pain extent, or the number of pain locations, was assessed using 36 predefined anatomical areas and patients indicated the areas where they experienced pain: (1) head/face [...] and (18) foot. The number of pain locations (range: 0–36) was summed.

Psychological factors via tools like the 13-item Pain Catastrophizing Scale (PCS) where one scores highly if they respond 'all the time' to questions like

"It’s awful and I feel that it overwhelms me", "I can’t seem to keep it out of my mind", "I keep thinking about how much it hurts" etc.

So if a patient reports that they experienced the worst possible pain in 36 body parts last week, this is taken as a biological fact, but if they also report that they feel overwhelmed by this situation, they are catastrophizing.

 

[Amw66]

FFS.
How did chronic pain become so misunderstood.
( Slight sarcasm - my partner has recent experience of pain clinics where the bps model is firmly entrenched )

Disappointingly the authors are mostly female . I doubt any of them has endometriosis.

 

[Hutan]

Psychosocial variables, more specifically perceived control and powerlessness, social support, and depression, were of particular importance to the symptom structure in this patient population. In contrast, biological factors appeared to have low relevance within this network.

The subjects here are women with tissue growing and bleeding where it shouldn't, for goodness sake, and these authors have decided that the women don't need to feel pain if they just thought properly. Of course there isn't a direct relationship between the amount of abnormal tissue and pain, because it depends on whether the tissue affects nerves or not.

CBT has proven to be effective for chronic pain and might be a promising candidate for improved quality of life in endometriosis.

Rubbish and rubbish.

 

[Amw66]

The subjects here are women with tissue growing and bleeding where it shouldn't, for goodness sake, and these authors have decided that the women don't need to feel pain if they just thought properly. Of course there isn't a direct relationship between the amount of abnormal tissue and pain, because it depends on whether the tissue affects nerves or not.




Rubbish and rubbish.

Is there something different about female pain?

There have been a growing number of messages/ news articles about gynaecological / medical procedures being done with no pain relief offered and pain has been excruciating.
It just doesn't seem to be a consideration.

 

[Midnattsol]

There have been a growing number of messages/ news articles about gynaecological / medical procedures being done with no pain relief offered and pain has been excruciating.
It just doesn't seem to be a consideration.

I'm not sure it's not a consideration, I know people who've asked for pain relief when they've had an intrauterine device (I realized I have no idea what it's called in English), and been told it can't hurt. So pain relief is not just not offered, you can be actively told you're the problem if you need it.