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Chronic pain after hysterectomy affects activities of daily living

Tristan Manalac
15 Apr 2018

In females who underwent either abdominal or laparoscopic hysterectomy, chronic posthysterectomy pain (CPHP) is common at 4 and 6 months postsurgery and appears to interfere significantly with daily activities, a recent Singapore study has shown.

At 4 months after the procedure, 175 participants completed the follow-up, of whom 32 percent reported persistent CPHP, the primary study outcome. The corresponding incidence rate in 159 participants who were not lost to follow-up at 6 months was 15.7 percent. None of the baseline characteristics were associated with pain at both time points. [J Pain Res 2018;11:629-636]

CPHP also seemed to negatively affect daily activities. For instance, at 4 months, pain from getting up from a chair (p=0.002), from sitting down for >30 minutes (p<0.001), from standing up for >30 minutes (p<0.001), from walking up or down stairs (p=0.036) and from carrying heavy bags (p<0.001) were significantly more common in CPHP patients.

At 6 months, pain from getting up from a chair (p=0.004) and from carrying heavy bags (p<0.001) remained significantly more frequent in CPHP patients, whereas pain from walking up and down stairs, and from extended periods of sitting and standing were attenuated.

The study initially included 216 females who were scheduled to receive elective abdominal or laparoscopic hysterectomy for benign conditions. Phone calls were placed at 4 and 6 months after the surgery, during which researchers asked about the presence of postoperative pain and resulting functional impairments.

Multivariate logistic regression analyses showed that at 4 months, a higher mechanical temporal summation (odds ratio [OR], 1.064; 95 percent CI, 1.03–1.099; p=0.0002), higher pain scores at the recovery room (OR, 1.389; 1.065–1.811; p=0.0153), 24-hour pain scores when coughing (OR, 1.135; 1.02–1.262; p=0.0201), itching within 24 hours after surgery (OR, 0.301; 0.103–0.874; p=0.0273) and preoperative lower abdominal pain (OR, 0.117; 0.027–0.513) were all significantly associated with CPHP.

At 6 months, only mechanical temporal summation (OR, 1.078; 1.041–1.117; p<0.0001) remained significant, while postoperative morphine consumption (OR, 1.172; 1.026–1.34; p=0.0196) and preoperative pain during sexual intercourse (OR, 5.312; 1.369–20.612; p=0.0158) were newly identified risk factors.

“In summary, the majority of CPHP cases recovered with time,” said researchers, noting that in those whose pain persisted, quality of life and daily living were compromised.

However, there were several study limitations, chief among them was the failure to include endometriosis in any of the analyses. “We felt that since endometriosis is associated with existing chronic pelvic pain condition, this could make the interpretation of our data difficult,” researchers explained.

In addition, while the most common and known potential confounders were controlled for in the statistical analyses, other unknown confounders that might have influenced the current results were not accounted for, they noted.

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