Determinants of Pain-Induced Disability in German Women with Endometriosis during the COVID-19 Pandemic

Abstract

(1) Background: The main aim of this research was to examine the factors leading to pain-induced disability by assessing the impact of demographic, endometriosis-specific, pandemic-specific, and mental health factors. (2) Methods: Women with endometriosis who attended online support groups were invited to respond to an online survey during the first wave of the COVID-19 pandemic in Germany. The Pain Disability Index (PDI) was employed to assess disability-related daily functioning. Independent predictors of pain-induced disability were determined using univariate and multivariate logistic regression analyses. (3) Results: The mean PDI score of the study population was 31.61 (SD = 15.82), which was significantly higher (p < 0.001) than that reported in a previously published normative study of the German population. In the present study, a high level of pain-induced disability, as defined by scores equal to or higher than the median of the study population, older age (OR 1.063, 95% CI 1.010–1.120, p = 0.020), dysmenorrhea (OR 1.015, 95% CI 1.005–1.026, p = 0.005), dysuria (OR 1.014; 95% CI 1.001–1.027, p = 0.029), lower back pain (OR 1.018, 95% CI 1.007–1.029, p = 0.001), and impaired mental health (OR 1.271, 95% CI 1.134–1.425, p < 0.001) were found to be independent risk factors. Pandemic-specific factors did not significantly influence the pain-induced disability of the participants in this study. (4) Conclusions: The level of pain-induced disability was significantly higher among the women with endometriosis than among women in the normative German validation study. Our findings identified risk factors for experiencing a high level of pain-induced disability, such as demographic and specific pain characteristics. Pandemic-specific factors did not significantly and independently influence the pain-induced disability during the first wave of the COVID-19 pandemic in Germany. Impaired mental health negatively influenced functioning during daily activities. Thus, women with endometriosis should be managed by a multidisciplinary team of healthcare professionals to prevent negative effects of pain-induced disability on their quality of life.

Factors Associated with Increased Analgesic Use in German Women with Endometriosis during the COVID-19 Pandemic

“…A large European survey revealed that 21% of study participants reported being diagnosed with depression as a result of a chronic pain disorder [ 11 ]. Depressive symptoms seem to play a major role in modifying the experiences and subsequent social and functional consequences of women with endometriosis [ 4 ]. Pain and depression might influence each other´s treatment, as has been shown in German patients with rheumatoid arthritis [ 37 ].…”

“…After initial diagnosis via laparoscopy and excision of the endometriotic lesions, pain persistence or recurrence is experienced by many patients [ 2 , 3 ]. The multidimensional chronic pain experience may lead to pain-induced disability in almost all areas of daily life [ 4 ]. As a result of the long diagnostic delay [ 5 ], women with endometriosis frequently use analgesics in order to mitigate pain and pain-induced disability long before the actual diagnosis, as well as after initial or recurrent surgical or hormonal therapy [ 6 , 7 , 8 ].…”

The ongoing impact of the Covid-19 pandemic on endometriosis patients: A survey of 1,089 UK patients

“…Of these, three published papers appear J.I. Spencer 1,2 , G. MezquIta 1 , F. ShakIr 1 to have analysed results from the same survey (Schwab et al,2021;Schwab et al, 2022a;Schwab et al,2022b). One mid-2020 case-control study in 1,027 patients in Iran showed no change in Covid-19 infection in endometriosis patients (Moazzami et al, 2021), whilst another smaller case-control study of 401 patients in Italy conducted between March 2020 and April 2021 showed a slight increase in number of infections in endometriosis patients (Barretta et al, 2022).…”

“…There are only 14 published studies examining the effects of Covid-19 on endometriosis patients ( Arena et al, 2021 ; Armour et al, 2022 ; Ashkenazi et al, 2022 ; Barretta et al, 2022 ; Demetriou et al, 2021 ; Evans et al, 2021 ; Moazzami et al, 2021 ; Nicolás et al, 2022 ; Rosielle et al, 2021 ; Schwab et al, 2021 ; Schwab et al, 2022a ; Schwab et al, 2022b ; Uccella et al, 2021 ; Yalçın Bahat et al, 2020 ). Of these, three published papers appear to have analysed results from the same survey ( Schwab et al, 2021 ; Schwab et al, 2022a ; Schwab et al, 2022b ).…”

“…There are only 14 published studies examining the effects of Covid-19 on endometriosis patients ( Arena et al, 2021 ; Armour et al, 2022 ; Ashkenazi et al, 2022 ; Barretta et al, 2022 ; Demetriou et al, 2021 ; Evans et al, 2021 ; Moazzami et al, 2021 ; Nicolás et al, 2022 ; Rosielle et al, 2021 ; Schwab et al, 2021 ; Schwab et al, 2022a ; Schwab et al, 2022b ; Uccella et al, 2021 ; Yalçın Bahat et al, 2020 ). Of these, three published papers appear to have analysed results from the same survey ( Schwab et al, 2021 ; Schwab et al, 2022a ; Schwab et al, 2022b ). One mid-2020 case-control study in 1,027 patients in Iran showed no change in Covid- 19 infection in endometriosis patients ( Moazzami et al, 2021 ), whilst another smaller case-control study of 401 patients in Italy conducted between March 2020 and April 2021 showed a slight increase in number of infections in endometriosis patients ( Barretta et al, 2022 ).…”