The Effect of Abuse History on Preoperative and Postoperative Pain Symptoms in Women Undergoing Surgical Treatment of Endometriosis

Abstract

<h3>Study Objective</h3> To assess the association between abuse history and pain symptoms in women undergoing surgery for endometriosis. <h3>Design</h3> Retrospective cohort study. <h3>Setting</h3> N/A <h3>Patients or Participants</h3> 140 women with pathology-proven endometriosis who underwent laparoscopy for excision of disease from 09/2015-11/2018. <h3>Interventions</h3> Data (type/timing of abuse, pre-operative symptoms, intraoperative findings and responses to surgical treatment) were collected using a standardized form at presentation and six weeks after surgery. Measurements and Main Results: Of 140 women, 56 (40%) had a history of emotional, physical, or sexual abuse. Overall preoperative pain score was higher in women with a history of abuse: sexual (6.8 vs. 5.5 p=0.039), physical (6.6 vs. 5.4 p=0.047) and emotional (6.8 vs. 5.4 p=0.006) though both groups had comparable intraoperative findings. Both groups had similar overall improvement of post-operative pain (table 1). Results remained unchanged after adjusting for potential confounders (pre-operative hormone use, surgical time, concomitant hysterectomy and/or bowel surgery, presence of deeply-infiltrating endometriosis or obliterated pouch of Douglas). Women who reported any abuse had higher pre-operative pain at ovulation (6.4 vs. 5.1, P=.020), post-operative pain with full bladder (2.2 vs. 1.2, P=.024), pain with urination (1.5 vs. 0.6, P=.007), and continued migraine headaches (3.1 vs. 1.4, P=.006). These differences were more pronounced with sexual or physical abuse in childhood compared to adulthood. <h3>Conclusion</h3> Women with a history of abuse had differences in preoperative presentation and postoperative outcomes, with the type and timing of abuse potentially playing a role. These results inform counseling women with this history on potential outcomes of endometriosis surgical interventions.