Analgesia in patients with adhesions-related chronic abdominal and pelvic pain after surgery: a systematic review

Abstract

Background and Objective Adhesions are the most common cause of chronic abdominal pain after surgery. Surgical adhesiolysis can relief symptoms in selected patients, but many require other treatments. The aim of this study is to evaluate analgesic treatments other than abdominal surgery in chronic pain related to adhesions. Database and Data Treatment: A search was conducted in PubMed, Embase and Central. Studies with patients suffering from chronic post-operative pain related to adhesions and undergoing all types’ analgesic treatment were included. Primary outcome was the number of patients who improved in pain at long-term follow up (at least one year). Secondary outcomes included improvement in pain at three months follow-up, quality of life, and physical functioning. Results Searches identified 3022 citations. Four studies were included, one trial, one cohort study and two case reports. The primary outcome was not reported. In a small trial (N = 18) pregabalin tended to have benefit over placebo improving pain at 3 months. In the cohort study seventeen patients with chronic pelvic pain underwent a trial of sacral nerve stimulation. Eight patients who responded positively received an implanted device for continues modulation, reporting sustainable improvement during follow-up (range: 6-36 months). One case report described improved pain at 6 months with trans-abdominis plane stimulation. The second report described improvement of physical function with manual therapy at long-term follow-up. Conclusions Low level of evidence is available regarding analgesic treatments of chronic abdominal and pelvic pain related to adhesions. Benefit of pregabalin is doubtful; nerve modulation is promising in a selected group. Highlights Adhesions are a frequent cause of chronic abdominal and pelvic pain after surgery. Many patients are not good candidates for surgery (Adhesiolysis) or have relapse of pain. There is an important knowledge gap regarding non-surgical analgesic treatment. Analgesia in adhesion-related chronic abdominal pain after surgery.