# Multidimensional Evaluation of Myofascial Pelvic Pain and Other Comorbidities in Endometriosis Patients

## TL;DR

This study finds that endometriosis patients with myofascial pelvic pain experience more pain, worse quality of life, and higher risk of depression and anxiety.

## Contribution

The study is the first to comprehensively evaluate myofascial pelvic pain in endometriosis patients alongside comorbidities and mental health.

## Key findings

- Patients with MPP reported higher endometriosis-associated pain and more comorbid symptoms.
- MPP patients had significantly worse health-related quality of life and higher anxiety and depression scores.
- Severe non-cyclic pelvic pain and high CSI scores were strongly associated with MPP.

## Abstract

Background/Objectives: Pain associated with endometriosis is complex and influenced by multiple factors. The presence of myofascial pelvic pain (MPP), associated comorbidities, and overlapping symptoms may play a role in endometriosis-associated pain. The aim of this study was to evaluate MPP in patients with endometriosis and correlate it with other self-reported comorbidities and symptoms, health-related quality of life, and mental health. Methods: A cross-sectional study was carried out at a tertiary hospital referral center on 175 women with endometriosis. MPP was evaluated by clinical examination; if present, the patient was allocated to the MPP group (n = 84), and if absent, the patient was allocated to the non-MPP group (n = 91). Other comorbidities and symptoms frequently found in patients with chronic pain were also recorded. The Short Form 36-Item health questionnaire (SF-36) and the Hospital Anxiety and Depression Scale (HADS) were administered. Central sensitization-related symptoms were assessed using the Central Sensitization Inventory (CSI). Results: Patients with MPP showed significantly higher scores related to endometriosis-associated pain, reported lower scores in all domains of the SF-36, and higher scores in the HADS questionnaire. This group also reported more comorbid symptoms and showed higher scores in the CSI questionnaire. In the multivariate analysis, severe non-cyclic pelvic pain, abdominal bloating, and CSI ≥ 40 remained significantly associated with the presence of MPP. Conclusions: Endometriosis patients with MPP presented more pain comorbidities and general symptoms. Moreover, they reported more endometriosis-associated pain and worse health-related quality of life, and they may be at higher risk of depression and anxiety.