Examination of Psychological Factors in Chronic Pelvic Pain
Many forms of chronic pelvic pain have no specific etiology or curative treatment. Catastrophizing, behavioural coping strategies, and depressive symptoms have all been noted in the chronic pain literature for their negative impact on multiple patient outcomes. The primary aim of this dissertation was to examine the predictive or mediating effect of catastrophizing, behavioural coping strategies, and depressive symptoms on pain among women with chronic pelvic pain. In Study 1, women with Interstitial Cystitis/Bladder Pain Syndrome (a chronic pelvic pain condition) completed questionnaires at three time points spanning 12 months. The directionality of the catastrophizing-pain relationship was tested using a cross-lagged panel analysis. Results suggest that changes in catastrophizing precede changes in pain but not vice versa. In Study 2, which used the same sample as Study 1, mediators and moderators of the catastrophizing-pain relationship were examined using a moderated multiple mediation model. Catastrophizing was found to directly affect pain. However, this direct catastrophizing-pain relationship was significant only for women with a clinically significant level of depressive symptoms. Additionally, catastrophizing indirectly affected pain through illness-focused coping strategies. Women with a greater tendency to catastrophize were more likely to engage in illness-focused coping and women who used more illness-focused coping strategies were more likely to experience greater levels of pain severity. In Study 3, which involved recruiting women with any diagnosed chronic pelvic pain condition, an experimental manipulation of induced negative mood (a proxy for depressive symptoms) was used to examine the effect of negative mood on pain tolerance for acute pain. No significant differences were found between participants who experienced induced negative mood and participants who experienced a neutral mood with regard to acute pain tolerance. The clinical implications of these findings for the management of chronic pelvic pain are discussed, particularly with regard to the identification and targeting of catastrophizing, illness-focused coping strategies, and depressive symptoms.