Comparaison de différents traitements psychologiques dans l'endométriose

The goal of the study was twofold. The first objective was to assess chronic endometriotic pain and its psychological dimensions (depression, anxiety, stress), and the consequences on the marital adjustment, and quality of life on women diagnosed with endometriosis by laparoscopy. The second objective was to compare two psychological treatments with a control group (no active treatment). Sixty women were randomly assigned to one of the treatment groups (Hypnosis, Cognitive-behavioural) or to the control group (Therapist Attention).  All measures were valid and the French translation had been adapted for the Quebec population. The statistical analysis were the Chi-square for nominal measures and ANOVAS for the continuous variables.  ANOVAS’s model estimate Treatment effect, Time effect and Interaction Group X Time.   Both interventions (Group effect) were significantly positive for the pain dimension on the McGill questionnaire but on the Evaluative dimension only (p = 0,02),  pain on “present” time on the Visual Analogue Scale (VAS,  p = 0,05), pain in the Quality of life scale (SF-36, p = 0,03), and on Social functioning dimension measured by SF-36 (p = 0,04).  When comparing data following treatment (post-treatment) with the baseline measures (pre-testing), Time effect occurred for the three groups on following variables: pain (McGill): Total score (p = 0, 03), Affective (p = 0, 04), Evaluative (p = 0,01), pain measured by a Visual analogue scale (VAS) at the Highest level (p < 0,0005), on  Depression  (p =  0,005), for State anxiety (p = 0,002), and Trait Anxiety (p <  0,001), on Stress (p = 0,003), and on four dimensions on the Quality of Life’s scale (SF-36): Social functioning (p = 0, 05), Vitality (p = 0,002), Pain (p = 0,003),  and Health change (p < 0,001) where the group Hypnosis seems to do better for the last variable.  Interaction effect (Group X Time) were statistically significant for dimension Activities in the Physical pain (SF-36, p = 0,02), and on State Anxiety (p = 0,007). Interaction effect close to statistically significant results (p = 0,08)  on Social functioning (SF-36) has also been analyze.  In this study, all group showed a comparable reduction of pain at the end of treatment, and an increase level of activities in the Cognitive-behavioural group. For the secondary variables the statistical results went in the same direction as the primary variable (pain). The level of depression, anxiety, and stress decreased with time for all groups. The study also showed a mild superiority of the Cognitive-behavioural treatment on State anxiety, Social functioning, and on Pain measured by the SF-36.  Statistical analysis didn’t show any change for the marital situation. Quality of life showed positive results on four scales only (social functioning, vitality, pain and perception change in health).  The study presents strengths (homogenous group, prospective study, control group and randomisation) and some weaknesses (small number of participants, potential bias with one interviewer, and absence of placebo group).  Even so, statistically significant results emerge and are promising for new studies with a higher number of subjects. We also recommend a long time follow-up. Future studies should take into account a distorted cognitive schema (catastrophization), personality traits well documented in chronic pain syndrome, and spouse’s role. We also recommend the use of “Motivational Interview” recently described in the literature.

Keyphrases: endometriosis, pain, depression, anxiety, stress, stress, marital adjustment, quality of life, psychological treatment, hypnosis, cognitive-behavioural