Incidence and predictors of persistent pelvic pain following hysterectomy in women with chronic pelvic pain.
Incidence and predictors of persistent pelvic pain following hysterectomy in women with chronic pelvic pain.
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慢性盆腔疼痛女性子宫切除术后持续性盆腔疼痛的发生率和预测因素。
DOI：
10.1016/j.ajog.2021.08.038
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发表时间：
2021-11
影响因子：
9.8
通讯作者：
中科院分区：
文献类型：
--
作者：
慢性盆腔疼痛（CPP）是一种使人衰弱的问题，困扰着美国15-20%的女性。尽管每年有超过20万例子宫切除术用于治疗CPP，但先前的研究表明，四分之一的女性经历了子宫切除术带来的不适和发病率，但疼痛并未得到缓解。预测治疗失败的因素仍然缺乏特征。描述慢性盆腔疼痛妇女子宫切除术后6个月内持续盆腔疼痛的发生率，并确定简单的自我报告中枢敏感化测量是否与子宫切除术后持续盆腔疼痛的风险增加有关。我们进行了一项前瞻性，观察队列研究的妇女接受子宫切除术良性指征在学术三级保健中心。术前慢性盆腔疼痛的患者，定义为在子宫切除术前3个月的0-10数值评定量表中平均盆腔疼痛≥3，纳入本分析。患者在术前和子宫切除术后6个月完成了疼痛、焦虑、抑郁和集中疼痛的有效评估（使用2011年纤维肌痛调查标准，0-31分）。从电子病历中提取人口统计信息、手术史、术中发现和手术病理。多因素logistic回归用于确定子宫切除术后6个月持续盆腔疼痛的独立预测因素，定义为盆腔疼痛严重程度改善<50%。在子宫切除术前有盆腔疼痛的176名参与者中，126名（71.6%）在6个月时保留，15名（11.9%）报告持续盆腔疼痛。年龄（p=0.46）、种族（p=0.55）、月经期间平均疼痛严重程度（p=0.68）、平均整体盆腔疼痛（p=0.10）或疼痛持续时间（p=0.80）在有和没有持续盆腔疼痛的患者中没有差异。单因素分析中，术中子宫内膜异位症（p=0.05）和子宫肌瘤（p=0.03）与持续疼痛的发生率较高相关，而手术路径（p=0.46）、盆腔粘连（0.51）、子宫重量（p=0.66）和组织病理学上的子宫腺肌症（p=0.27）与持续疼痛的风险无关。术前集中疼痛评分较高（p=0.01），但抑郁（p=0.64）或焦虑（p=0.45）在持续盆腔疼痛的女性中更常见。多因素logistic回归校正年龄、术前疼痛严重程度、焦虑、抑郁和子宫内膜异位症和子宫肌瘤的手术结果显示，子宫切除术前集中疼痛每增加1点，术后6个月持续盆腔疼痛的几率增加27% （OR 1.27, 95%CI 1.03, 1.57）。虽然大多数患有CPP的妇女报告子宫切除术后疼痛有相当大的改善，但子宫切除术前较高程度的集中疼痛是持续盆腔疼痛的有力预测因素。子宫切除术前较高程度的集中疼痛是术后6个月持续盆腔疼痛的有力预测因子。
Chronic Pelvic Pain (CPP) is a debilitating problem that afflicts 15-20% of women in the United States. Although over 200,000 hysterectomies are performed annually for the treatment of CPP, prior studies indicate that one in four women undergo the discomfort and morbidity of hysterectomy without relief of pain. Factors that predict treatment failure remain poorly characterized. To describe the incidence of persistent pelvic pain in the 6 months following hysterectomy in women with chronic pelvic pain and determine whether a simple, self-report measure of central sensitization is associated with a greater risk of persistent pelvic pain following hysterectomy. We conducted a prospective, observational cohort study of women undergoing hysterectomy for a benign indication at an academic tertiary care center. Patients with preoperative chronic pelvic pain, defined as average pelvic pain ≥3 on a 0-10 numeric rating scale for >3 months prior to hysterectomy, were included in this analysis. 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. Multivariate logistic regression was used to identify independent predictors of persistent pelvic pain 6 months following hysterectomy, defined as <50% improvement in pelvic pain severity. Among 176 participants with pelvic pain prior to hysterectomy, 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), average pain severity during menses (p=0.68), average overall pelvic pain (p=0.10), or pain duration (p=0.80) in those with and without persistent pelvic pain. While intraoperative findings of endometriosis (p=0.05) and uterine fibroids (p=0.03) were associated with a higher incidence of persistent pain on univariate analysis, surgical route (p=0.46), pelvic adhesions (0.51), uterine weight (p=0.66) and adenomyosis on histopathology (p=0.27), were not related to risk of persistent pain. Higher preoperative centralized pain scores (p=0.01), but not depression (p=0.64) or anxiety (p=0.45) 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 prior to hysterectomy was associated with a 27% increase in odds of persistent pelvic pain (OR 1.27, 95%CI 1.03, 1.57) 6-months after surgery. 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 pelvic pain. Higher degrees of centralized pain prior to hysterectomy are a robust predictor of persistent pelvic pain 6 months after surgery.
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影响因子：
13.3
作者：
Brawn J;Morotti M;Zondervan KT;Becker CM;Vincent K
通讯作者：
Vincent K
影响因子：
7.2
作者：
Kjerulff, KH;Langenberg, PW;Stolley, PD
通讯作者：
Stolley, PD
影响因子：
8.8
作者：
Brandsborg, Birgitte;Nikolajsen, Lone;Jensen, Troels S.
通讯作者：
Jensen, Troels S.
影响因子：
6.7
作者：
NAMNOUM, AB;GEHLBACH, DL;GOODMAN, SB
通讯作者：
GOODMAN, SB
影响因子：
13.3
作者：
Brummett, Chad M.;Urquhart, Andrew G.;Hassett, Afton L.;Tsodikov, Alex;Hallstrom, Brian R.;Wood, Nathan I.;Williams, David A.;Clauw, Daniel J.
通讯作者：
Clauw, Daniel J.