Purpose: This study aimed to investigate the reciprocal relationship between endometriosis-related pain and the consumption of cannabinoids and opioids. Additionally, this study explores whether pain-related anxiety acts as a mediator in this relationship by adopting a transactional model of adaptation to endometriosis. Methods: This cross-sectional study included 334 adult women diagnosed with endometriosis. An online questionnaire, distributed through social networks and patient associations, gathered data on pain intensity, substance use (cannabis, CBD, and opioids), pain-related anxiety, distress tolerance, and anxiety sensitivity. Results: Descriptive statistics revealed that 74.25% of participants reported using at least one substance. Pain was positively correlated with the severity level of CBD, opioid use, and pain-related anxiety. The severity level of cannabis uses negatively correlated with distress tolerance. Path modeling demonstrated that substance use predicted pain intensity, and that pain intensity is associated with pain-related anxiety, subsequently influencing substance use. The model suggests a transactional relationship between pain, pain-related anxiety, and substance use. Conclusions: These findings underscore the need for tailored therapeutic approaches for women with endometriosis. Substance use is associated with increased pain intensity, indicating a complex interplay. This study highlights the importance of considering psychosocial factors such as pain-related anxiety in understanding the relationship between substance use and pain in endometriosis. A comprehensive approach to care involving both medical and psychological perspectives is essential. Further studies are also required.
Broc et al. (2026) studied this question.