Incidence and predictors of persistent pelvic pain following hysterectomy in women with chronic pelvic pain - 24/09/21
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Abstract |
Background |
Chronic pelvic pain is a debilitating problem that afflicts 15% to 20% of women in the United States. Although more than 200,000 hysterectomies are performed annually for the treatment of chronic pelvic pain, previous studies indicate that 1 in 4 women undergo the discomfort and morbidity of hysterectomy without the relief of pain. The factors that predict treatment failure remain poorly characterized.
Objective |
To describe the incidence of persistent pelvic pain 6 months following hysterectomy in women with chronic pelvic pain and determine whether a simple, self-reported measure of central sensitization is associated with a greater risk of persistent pelvic pain following hysterectomy.
Study Design |
We conducted a prospective, observational cohort study of women undergoing hysterectomy at an academic tertiary care center for a benign indication. Patients with preoperative chronic pelvic pain, defined as average pelvic pain ≥3 on a 0 to 10 numeric rating scale for >3 months before hysterectomy, were included in this analysis. The patients completed validated assessments of pain, anxiety, depression, and centralized pain (using the 2011 Fibromyalgia Survey Criteria, 0–31 points) preoperatively and 6 months after hysterectomy. The demographic information, surgical history, intraoperative findings, and surgical pathology were abstracted from the electronic medical records. Multivariate logistic regression was used to identify the independent predictors of persistent pelvic pain 6 months following hysterectomy, defined as <50% improvement in pelvic pain severity.
Results |
Among 176 participants with pelvic pain before hysterectomy, 126 (71.6%) were retained at 6 months, and 15 (11.9%) reported persistent pelvic pain. There was no difference in age (P=.46), race (P=.55), average pain severity during menses (P=.68), average overall pelvic pain (P=.10), or pain duration (P=.80) in those with and without persistent pelvic pain. Whereas intraoperative findings of endometriosis (P=.05) and uterine fibroids (P=.03) were associated with a higher incidence of persistent pain on univariate analysis, the surgical route (P=.46), pelvic adhesions (0.51), uterine weight (P=.66), and adenomyosis on histopathology (P=.27) were not related to the risk of persistent pain. Higher preoperative centralized pain scores (P=.01) but not depression (P=.64) or anxiety (P=.45) were more common in women with persistent pelvic pain. Multivariate logistic regression adjusting for age, preoperative pain severity, anxiety, depression, and operative findings of endometriosis and fibroids indicated that every 1-point increase in centralized pain before hysterectomy was associated with a 27% increase in the odds of persistent pelvic pain (odds ratio, 1.27; 95% confidence interval, 1.03–1.57) 6 months after surgery.
Conclusion |
Although the majority of women with chronic pelvic pain report considerable improvement in pain following hysterectomy, higher degrees of centralized pain before hysterectomy is a robust predictor of persistent pelvic pain.
Le texte complet de cet article est disponible en PDF.Key words : central sensitization, centralized pain, endometriosis, fibromyalgia, hysterectomy, nociplastic pain, pelvic pain, persistent pain
Plan
S.A. is a consultant for AbbVie, Myovant, Bayer, and Eximis, and receives author royalties from UpToDate. C.M.B. is a consultant for Heron Therapeutics (San Diego, CA), Vertex Pharmaceuticals (Boston, MA), and Alosa Health (Boston, MA) and he provides expert testimony. S.A.M. is a consultant for AbbVie and Roche and currently receives grant funding from the National Institutes of Health (NIH), the Department of Defense, and AbbVie. The remaining authors report no conflict of interest. |
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S.A. is supported by Eunice Kennedy Shriver National Institute of Child Health and Human Development R01 HD088712. C.M.B. is supported by National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) R01AR060392, NIAMS P50 AR070600, National Institute on Drug Abuse (NIDA) R01DA038261, NIDA R01DA042859, and Common Fund UM1 NS118922. A.D.S. is supported, in part, by NIH R43 DA046981. S.R.T. is supported by Eunice Kennedy Shriver National Institute of Child Health and Human Development 1K23HD09928301A1. Additional support has been received from the Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan. |
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Cite this article as: As-Sanie S, Till SR, Schrepf AD, et al. Incidence and predictors of persistent pelvic pain following hysterectomy in women with chronic pelvic pain. Am J Obstet Gynecol 2021;XX:x.ex–x.ex. |
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