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Chronic pelvic pain – pain catastrophizing, pelvic pain and quality of life

Megan Sewell, Leonid Churilov, Samantha Mooney, Tony Ma, Peter Maher and Sonia R. Grover


Background and aims

Chronic pelvic pain (CPP) impacts significantly on the lives of women. Negative coping responses such as pain catastrophizing are thought to be significant in predicting both pain severity and outcome. The combined effect of the individual’s response to pain and its severity on their quality of life (QoL) has not been well studied in women with CPP. Aims were to determine the prevalence of pain catastrophizing in women with CPP and to examine the associations between pain catastrophizing and levels of dysmenorrhea, non-cyclical pelvic pain, dyspareunia, dysuria, dyschezia and QoL.


A cross-sectional study including women aged 18–50 years, referred to a tertiary gynecology outpatients department at an Australian women’s hospital in 2015. Participants completed questionnaires including: pain catastrophizing scale (PCS); pelvic pain levels in the prior 3 months; and the World Health Organisation Quality of life – Bref Questionnaire (WHOQoL-Bref). Statistical analysis was performed using STATA (StataCorp, USA Version13).


Participants (n = 115) had a median age of 29.0 [interquartile range (IQR): 23.0–38.0] years. The Pain catastrophizing score revealed that 60/113 [95% confidence interval (CI): 48.6, 71.2] of participants had a clinically relevant total score ≥30. There were statistically significant positive correlations between pain catastrophizing scores and pelvic pain levels in all five pain categories studied, dysmenorrhea (ρ = 0.37, p = 0.0001), non-cyclical pelvic pain (ρ = 0.46, p<0.0001), dyspareunia (ρ = 0.32, p = 0.0008), dysuria (ρ = 0.32, p = 0.0005) and dyschezia (ρ = 0.38, p = 0.0012). Participants who reported maximal pain levels (5/5) had significantly higher median pain catastrophizing scores when compared to those who reported no pain (0/5) in all categories. Overall QoL was considered as “good” in 71/113 (95% CI: 60.1, 81.0) participants and “poor” in 42/113 (95% CI: 32.0, 53.0) participants. Comparison to Australian female norms revealed significantly lower QoL scores in the physical domain, across all ages, and in psychological domain for those aged <30 and 30–40 years. There was a significant association between increased catastrophizing scores and reduced odds of good QoL. An increase in PCS by one point is associated with a 6.3% decrease in the odds of good QoL [odds ratio (OR) per one-point increase: 0.94 (95% CI: 0.89, 0.98), p = 0.008].


Pain catastrophizing is prevalent at clinically relevant levels in women with CPP across all domains. It is associated with higher pain levels and decreased QoL.


There is potential for further studies to investigate the predictive nature of pain catastrophizing and management targeting catastrophizing to improve outcomes in women with CPP.


We wish to express our gratitude and thanks to Mrs Jennifer Porter, and the Mercy Hospital for Women’s Gynaecology Units; Plenty Gynaecology and Endosurgery A.

  1. Authors’ statements

  2. Research funding: Financial support by The Norman Beischer Medical Research Foundation.

  3. Conflict of interest: The authors report no conflict of interest.

  4. Informed consent: Informed written consent was received from every participant.

  5. Ethical approval: Ethics was approved by Mercy Health, HREC.


[1] Grace VM, Zondervan KT. Chronic pelvic pain in New Zealand: prevalence, pain severity, diagnoses and the use of the health services. Aus N Z J Public Health 2004;28:369–75.10.1111/j.1467-842X.2004.tb00446.x Search in Google Scholar

[2] Williams R, Hartmann K, Steege JF. Documenting the current definitions of chronic pelvic pain: implications for research. Obstet Gynecol 2004;103:686–91.1505156010.1097/01.AOG.0000115513.92318.b7 Search in Google Scholar

[3] Cox L, Ayers S, Mala K, Penny J. Chronic pelvic pain and quality of life after laparoscopy. Eur J Obstet Gynecol Reprod Biol 2007;132:214–9.1673087410.1016/j.ejogrb.2006.04.020 Search in Google Scholar

[4] Mathias SD, Kuppermann M, Liberman RF, Lipshutz RC, Steege JF. Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet Gynecol 1996;87:321–7.859894810.1016/0029-7844(95)00458-0 Search in Google Scholar

[5] Fagervold B, Jenssen M, Hummelshoj L, Moen MH. Life after a diagnosis with endometriosis – a 15 years follow-up study. Acta Obstet Gynecol Scand 2009;88:914–9.10.1080/0001634090310830819568961 Search in Google Scholar

[6] Bush D, Evans S, Vancaillie T. The Pelvic Pain Report: the $6 Billion Woman and the $600 Million Girl. Pain Australia, Faculty of Pain Medicine ANZCA. 2011:1–74. Search in Google Scholar

[7] Howard FM. Chronic pelvic pain. Obstet Gynecol 2003;101: 594–611.12636968 Search in Google Scholar

[8] Yunker A, Sathe NA, Reynolds WS, Likis FE, Andrews J. Systematic review of therapies for noncyclic chronic pelvic pain in women. Obstet Gynecol Surv 2012;67:417–25.10.1097/OGX.0b013e31825cecb322926248 Search in Google Scholar

[9] Howard FM. Laparoscopic evaluation and treatment of women with chronic pelvic pain. J Am Assoc Gynecol Laparosc 1994;1:325–31.913887310.1016/S1074-3804(05)80797-2 Search in Google Scholar

[10] Latthe P, Latthe M, Say L, Gulmezoglu M, Khan KS. WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity. BMC Public Health 2006;6:177.10.1186/1471-2458-6-17716824213 Search in Google Scholar

[11] Thomten J, Linton SJ. A psychological view of sexual pain among women: applying the fear-avoidance model. Women’s Health (Lond) 2013;9:251–63. Search in Google Scholar

[12] Sullivan MJ, Thorn B, Haythornthwaite JA, Keefe F, Martin M, Bradley LA, Lefebvre JC. Theoretical perspectives on the relation between catastrophizing and pain. Clin J Pain 2001;17:52–64.10.1097/00002508-200103000-0000811289089 Search in Google Scholar

[13] Sullivan M. The Pain Catastrophizing Scale; User Manual. 2009. Search in Google Scholar

[14] Sullivan M, Bishop SR, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess 1995;7:524–32.10.1037/1040-3590.7.4.524 Search in Google Scholar

[15] Suren M, Kaya Z, Gokbakan M, Okan I, Arici S, Karaman S, Comlekci M, Balta MG, Dogru S. The role of pain catastrophizing score in the prediction of venipuncture pain severity. Pain Pract 2014;14:245–51.10.1111/papr.1206023586760 Search in Google Scholar

[16] Picavet HS, Vlaeyen JW, Schouten JS. Pain catastrophizing and kinesiophobia: predictors of chronic low back pain. Am J Epidemiol 2002;156:1028–34.10.1093/aje/kwf13612446259 Search in Google Scholar

[17] Martin CE, Johnson E, Wechter ME, Leserman J, Zolnoun DA. Catastrophizing: a predictor of persistent pain among women with endometriosis at 1 year. Hum Reprod 2011;26:3078–84.2190039310.1093/humrep/der292 Search in Google Scholar

[18] As-Sanie S, Harris RE, Napadow V, Kim J, Neshewat G, Kairys A, Williams D, Clauw DJ. Schmidt-Wilcke T. Increased pressure pain sensitivity in women with chronic pelvic pain. Obstet Gynecol 2013;122:1047–55.10.1097/AOG.0b013e3182a7e1f524104772 Search in Google Scholar

[19] The WHOQOLGroup, Development of the World Health Organization WHOQOL-BREF Quality of Life Assessment. Psychol Med 1998;28:551–8.9626712 Search in Google Scholar

[20] Hawthorne G, Herman H, Murphy B. Interpreting the WHOQOL-Brèf: preliminary population norms and effect sizes. Soc Indic Res 2006;77:37–59.10.1007/s11205-005-5552-1 Search in Google Scholar

[21] Roth ML, Tripp DA, Harrison MH, Sullivan M, Carson P. Demographic and psychosocial predictors of acute perioperative pain for total knee arthroplasty. Pain Res Manag 2007;12:185–94.10.1155/2007/39496017717610 Search in Google Scholar

[22] Desrochers G, Bergeron S, Khalife S, Dupuis MJ, Jodoin M. Fear avoidance and self-efficacy in relation to pain and sexual impairment in women with provoked vestibulodynia. Clin J Pain 2009;25:520–7.10.1097/AJP.0b013e31819976e319542801 Search in Google Scholar

[23] Laursen BS, Bajaj P, Olesen AS, Delmar C, Arendt-Nielsen L. Health related quality of life and quantitative pain measurement in females with chronic non-malignant pain. Eur J Pain 2005;9:267–75.10.1016/j.ejpain.2004.07.00315862476 Search in Google Scholar

[24] Jones GL, Kennedy SH, Jenkinson C. Health-related quality of life measurement in women with common benign gynecologic conditions: a systematic review. Am J Obstet Gynecol 2002;187:501–11.10.1067/mob.2002.12494012193950 Search in Google Scholar

[25] Tripoli TM, Sato H, Sartori MG, de Araujo FF, Girao MJ, Schor E. Evaluation of quality of life and sexual satisfaction in women suffering from chronic pelvic pain with or without endometriosis. J Sex Med 2011;8:497–503.10.1111/j.1743-6109.2010.01976.x20722779 Search in Google Scholar

Article note

Research was presented at the Australian Pain Society 36th Annual Scientific Meeting in March 2016.

Received: 2017-12-10
Revised: 2018-03-16
Accepted: 2018-03-18
Published Online: 2018-04-13
Published in Print: 2018-07-26

©2018 Scandinavian Association for the Study of Pain. Published by Walter de Gruyter GmbH, Berlin/Boston. All rights reserved