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

被引:46
作者
As-Sanie, Sawsan [1 ]
Till, Sara R. [1 ]
Schrepf, Andrew D. [2 ,4 ]
Griffith, Kendall C. [1 ]
Tsodikov, Alex [3 ]
Missmer, Stacey A. [5 ]
Clauw, Daniel J. [2 ,4 ]
Brummett, Chad M. [2 ,4 ]
机构
[1] Univ Michigan, Dept Obstet & Gynecol, Ann Arbor, MI 48109 USA
[2] Univ Michigan, Dept Anesthesiol, Ann Arbor, MI 48109 USA
[3] Univ Michigan, Dept Biostat, Ann Arbor, MI 48109 USA
[4] Univ Michigan, Chron Pain & Fatigue Res Ctr, Ann Arbor, MI 48109 USA
[5] Michigan State Univ, Coll Human Med, Dept Obstet Gynecol & Reprod Biol, Grand Rapids, MI USA
关键词
central sensitization; centralized pain; endometriosis; fibromyalgia; hysterectomy; nociplastic pain; pelvic pain; persistent pain; QUALITY-OF-LIFE; RISK-FACTORS; ENDOMETRIOSIS; IMPACT;
D O I
10.1016/j.ajog.2021.08.038
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
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, intra-operative 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.
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页数:11
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