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The Importance of Pain Imagery in Women with Endometriosis-Associated Pain, and Wider Implications for Patients with Chronic Pain

  • Christopher J. GrahamEmail author
  • Shona L. Brown
  • Andrew W. Horne
Chapter

Abstract

Pain imagery is “like having a picture in your head [of your pain] which may include things you can imagine seeing, hearing or feeling.” Pain imagery may offer a unique insight into a patient’s pain experience. This chapter summarises findings from international pain imagery research in women with endometriosis-associated pain. Endometriosis is a chronic inflammatory condition associated with debilitating pain that affects 5–10% of women of reproductive age worldwide. Our international research has found that pain imagery is experienced by around half of women suffering from endometriosis-associated pain, and is associated with higher levels of catastrophising, depression, and anxiety. However, coping imagery is also reported, and prevalent, at 30%. Pain imagery in women with endometriosis falls into themes: sensory qualities of pain; loss of power or control; attack (by someone, “something,” or self); pathology or anatomy envisaged; past or future catastrophe; pain as an object; and abstract images. Imagery content may therefore reveal the meanings of pain or endometriosis to these women. This chapter explores pain imagery content and its personal significance to patients, both for women with endometriosis-associated pain and for patients with other chronic pain conditions. The chapter concludes by discussing the clinical application of imagery, with example patient cases to contextualise the practicalities and therapeutic potential of imagery techniques.

Clinical Implications: Pain imagery was reported by half of women with endometriosis-associated pain in our international study and associated with higher levels of catastrophising, depression, and anxiety. Imagery content is extremely varied but can be categorised into themes, which may offer unique insights into each woman’s pain experience. Coping imagery was prevalent at 30%. We believe imagery techniques may be particularly helpful for women with endometriosis-associated pain and discuss these techniques, which should be of interest to professionals involved in pain management.

Keywords

Endometriosis Persistent pelvic pain Chronic pelvic pain Pain imagery Coping imagery Imagery-based therapies 

Notes

Acknowledgments

The authors are grateful to Dr. Simon van Rysewyk for his edits of this chapter; Dr. David Gillanders for offering comment on questionnaire design; Dr. Katy Vincent for expert review of our international research; the creators and distributors of the validated and reliable measures: Short-Form McGill Pain Questionnaire 2 ([39] access from Mapi Research Trust: https://eprovide.mapi-trust.org, adapted with permission), Pain Catastrophizing Scale ([40] now access is also from Mapi Research Trust: https://eprovide.mapi-trust.org), and Depression, Anxiety and Positive Outlook Scale [41]; all of the endometriosis patient organisations (Endometriosis UK, Endometriosis Foundation of America, Endometriosis.org, Endometriosis New Zealand, Endometriosis Australia, and The Endometriosis Network Canada) for advertising the online survey; and all of the participants who completed the questionnaire. The international pain imagery research was supported by an MRC Centre Grant (MR/N022556/1).

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Christopher J. Graham
    • 1
    Email author
  • Shona L. Brown
    • 2
  • Andrew W. Horne
    • 1
  1. 1.MRC Centre for Reproductive HealthUniversity of Edinburgh, The Queen’s Medical Research InstituteEdinburghScotland
  2. 2.Department of Clinical PsychologyNHS Lothian, Astley Ainslie HospitalEdinburghScotland

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