Incidence and Predictors of Persistent Pelvic Pain Following Hysterectomy in Women with Chronic Pelvic Pain

Abstract

Study Objective To describe the incidence and risk factors for persistent pelvic pain 6 months following hysterectomy in women with chronic pelvic pain (CPP). Design Prospective, observational cohort study of women with chronic pelvic pain undergoing hysterectomy. Setting Academic tertiary care center. Patients or Participants 126 women with CPP undergoing hysterectomy for benign indications. Interventions 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. Demographic information, surgical history, intraoperative findings and surgical pathology were abstracted from the electronic medical record. Preoperative CPP was defined as average pelvic pain ≥3/10 for >3 months. Multivariate logistic regression was used to identify independent predictors of persistent pelvic pain 6 months following hysterectomy, defined as Measurements and Main Results Among 176 participants with CPP, 126 (71.6%) were retained at 6-months, and 15 (11.9%) reported persistent pelvic pain. There was no difference in age (p=0.46), race (p=0.55), pain severity (p=0.10) or pain duration (p=0.80) in those with and without persistent pelvic pain. While intraoperative findings of endometriosis (p=0.045) was associated with a higher incidence of persistent pain, surgical route (p=0.46), uterine fibroids (p=0.34), adenomyosis (p=0.23), pelvic adhesions (0.51), uterine weight (p=0.66) were not related to risk of persistent pain. Higher preoperative centralized pain scores (p=0.01), but not depression (p=0.13) or anxiety (p=0.28) were more common in women with persistent pelvic pain. Multivariate logistic regression controlling for age, anxiety, and endometriosis indicated that every 1-point increase in centralized pain was associated with a 23% increase in odds of persistent pelvic pain (OR 1.23, 95%CI 1.03, 1.48). Conclusion While the majority of women with CPP report considerable improvement in pain following hysterectomy, higher degrees of centralized pain prior to hysterectomy is a robust predictor of persistent pain, even among women whose score falls below the diagnostic criteria for fibromyalgia.