Incidence and predictors of persistent pelvic pain following hysterectomy in women with chronic pelvic pain

As‐Sanie, Sawsan; Till, Sara R.; Schrepf, Andrew; Griffith, Kendall C.; Tsodikov, Alex; Missmer, Stacey A.; Clauw, Daniel J.; Brummett, Chad M.

doi:10.1016/j.ajog.2021.08.038

Cited by 44 publications

(40 citation statements)

References 30 publications

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“… 46 Furthermore, Roh et al 47 found that centrally mediated symptoms measured by the CSI were associated with poor functional outcome at 3 months after carpal tunnel surgery, although this association diminished at 12 months. A prospective, observational study by As-Sanie et al 48 found that the odds of persistent pelvic pain at 6 months after hysterectomy for benign indications increased by 27% for every 1-point increase in central sensitization pain on the Fibromyalgia Survey. Together, these studies 27 , 46 indicate that a higher degree of centralized pain may be associated with persistent chronic pain after surgery.…”

Section: Discussionmentioning

confidence: 99%

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Association of Central Sensitization Inventory Scores With Pain Outcomes After Endometriosis Surgery

et al. 2023

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ImportanceA subset of people who undergo surgery for endometriosis have persistent pain, suggesting that other factors besides the endometriosis, such as central sensitization, may play a role in this pain. The Central Sensitization Inventory, a validated self-reported questionnaire of central sensitization symptoms, may identify individuals with endometriosis who have more pain after surgery due to pain sensitization.ObjectiveTo examine whether greater baseline Central Sensitization Inventory scores are associated with postsurgical pain outcomes.Design, Setting, and ParticipantsThis prospective, longitudinal cohort study performed at a tertiary center for endometriosis and pelvic pain in British Columbia, Canada, included all patients aged 18 to 50 years with diagnosed or suspected endometriosis and a baseline visit between January 1, 2018, and December 31, 2019, who underwent surgery after the baseline visit. Individuals who were menopausal, had a prior hysterectomy, or were missing data for outcomes or measures were excluded. Data analysis was performed from July 2021 to June 2022.Main Outcomes and MeasuresThe primary outcome was chronic pelvic pain at follow-up measured on a scale of 0 to 10, with 0 to 3 indicating no pain or mild pain, 4 to 6 indicating moderate pain, and 7 to 10 indicating severe pain. Secondary outcomes were deep dyspareunia, dysmenorrhea, dyschezia, and back pain at follow-up. The main variable of interest was baseline Central Sensitization Inventory score (measured from 0 to 100, consisting of 25 self-reported questions rated from 0 to 4 [never, rarely, sometimes, often, and always, respectively]).ResultsA total of 239 patients (mean [SD] age, 34 [7] years; 189 [79.1%] White [11 (5.8%) identified as White mixed with another ethnicity], 1 [0.4%] Black or African American, 29 [12.1%] Asian, 2 [0.8%] Native Hawaiian or Pacific Islander, 16 [6.7%] other, and 2 [0.8%] mixed race or ethnicity) with follow-up data at more than 4 months after surgery were included in this study (71.0% follow-up rate). The mean (SD) baseline Central Sensitization Inventory score was 43.8 (18.2), and the mean (SD) follow-up was 16.1 (6.1) months. Higher baseline Central Sensitization Inventory scores were significantly associated with higher chronic pelvic pain (odds ratio [OR], 1.02; 95% CI, 1.00-1.03; P = .02), deep dyspareunia (OR, 1.03; 95% CI, 1.01-1.04; P = .004), dyschezia (OR, 1.03; 95% CI, 1.01-1.04; P &lt; .001), and back pain (OR, 1.02; 95% CI, 1.00-1.03; P = .02) at follow-up, when controlling for baseline pain scores. The Central Sensitization Inventory scores themselves decreased slightly from baseline to follow-up (mean [SD] score, 43.8 [18.2] vs 41.7 [18.9]; P = .05); however, individuals with high baseline Central Sensitization Inventory scores still had high scores at follow-up.Conclusions and RelevanceIn this cohort study of 239 patients with endometriosis, higher Central Sensitization Inventory scores at baseline were associated with worse pain outcomes after endometriosis surgery, when controlling for baseline pain scores. The Central Sensitization Inventory could be used to counsel patients with endometriosis on their expected outcomes after surgery.

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Section: Discussionmentioning

confidence: 99%

“…association diminished at 12 months. A prospective, observational study by As-Sanie et al 48 found that the odds of persistent pelvic pain at 6 months after hysterectomy for benign indications increased by 27% for every 1-point increase in central sensitization pain on the Fibromyalgia Survey.…”

Section: Follow-up Baselinementioning

confidence: 99%

Association of Central Sensitization Inventory Scores With Pain Outcomes After Endometriosis Surgery

et al. 2023

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“…In prospective studies of repeat surgeries, lesions progressed (in 29% of cases), regressed (in 42%), or were static (in 29%) 152. Surgical treatment of certain subtypes of endometriosis could also exacerbate painful symptoms 153154…”

Section: Management Of Endometriosis Associated Painmentioning

confidence: 99%

Pathophysiology, diagnosis, and management of endometriosis

Horne

Missmer

2022

BMJ

213

104

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Endometriosis affects approximately 190 million women and people assigned female at birth worldwide. It is a chronic, inflammatory, gynecologic disease marked by the presence of endometrial-like tissue outside the uterus, which in many patients is associated with debilitating painful symptoms. Patients with endometriosis are also at greater risk of infertility, emergence of fatigue, multisite pain, and other comorbidities. Thus, endometriosis is best understood as a condition with variable presentation and effects at multiple life stages. A long diagnostic delay after symptom onset is common, and persistence and recurrence of symptoms despite treatment is common. This review discusses the potential genetic, hormonal, and immunologic factors that lead to endometriosis, with a focus on current diagnostic and management strategies for gynecologists, general practitioners, and clinicians specializing in conditions for which patients with endometriosis are at higher risk. It examines evidence supporting the different surgical, pharmacologic, and non-pharmacologic approaches to treating patients with endometriosis and presents an easy to adopt step-by-step management strategy. As endometriosis is a multisystem disease, patients with the condition should ideally be offered a personalized, multimodal, interdisciplinary treatment approach. A priority for future discovery is determining clinically informative sub-classifications of endometriosis that predict prognosis and enhance treatment prioritization.

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“…Patients who filled out both LAO and SAO prescriptions had the highest total day supply of opioids, the proportion of days covered by prescriptions, and morphine equivalent daily dose. These patients also had the highest proportions of opioid switching and dose augmentation in a retrospective analysis, with the study concluding that women with EM have higher probabilities of prolonged use of opioids and concomitant use with benzodiazepines compared with women without this condition [ 137 , 138 ]. An additional retrospective study from 2009 to 2018 evaluated all-cause and EM-related health care resource utilization and costs among newly diagnosed patients with high risk (≥1 day with ≥90 morphine milligram equivalents per day or ≥ 1 day concomitant benzodiazepine use) versus low risk opioid use or patients with chronic (≥90-day supply prescribed or ≥10 opioid prescriptions) versus non-chronic opioid use.…”

Section: Drug Abuse and Addiction To Opioidsmentioning

confidence: 99%

Endometriosis and Opioid Receptors: Are Opioids a Possible/Promising Treatment for Endometriosis?

Guan

Velho²,

Sehouli³

et al. 2023

IJMS

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Endometriosis (EM), defined as the presence of endometrial-like tissue with surrounding smooth muscle cells outside the uterus, is a disregarded gynecological disease reported to affect 6–10% of women of reproductive age, with 30–50% of them suffering from chronic pelvic pain and infertility. Since the exact pathogenic mechanisms of EM are still unclear, no curative therapy is available. As pain is an important factor in EM, optimal analgesia should be sought, which to date has been treated primarily with non-steroidal anti-inflammatory drugs (NSAIDs), metamizole or, in extreme cases, opioids. Here, we review the pain therapy options, the mechanisms of pain development in EM, the endogenous opioid system and pain, as well as the opioid receptors and EM-associated pain. We also explore the drug abuse and addiction to opioids and the possible use of NOP receptors in terms of analgesia and improved tolerability as a target for EM-associated pain treatment. Emerging evidence has shown a promising functional profile of bifunctional NOP/MOP partial agonists as safe and nonaddictive analgesics. However, until now, the role of NOP receptors in EM has not been investigated. This review offers a thought which still needs further investigation but may provide potential options for relieving EM-associated pain.

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Incidence and predictors of persistent pelvic pain following hysterectomy in women with chronic pelvic pain

Cited by 44 publications

References 30 publications

Association of Central Sensitization Inventory Scores With Pain Outcomes After Endometriosis Surgery

Association of Central Sensitization Inventory Scores With Pain Outcomes After Endometriosis Surgery

Pathophysiology, diagnosis, and management of endometriosis

Endometriosis and Opioid Receptors: Are Opioids a Possible/Promising Treatment for Endometriosis?

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