Background

Chronic pelvic pain is a debilitating problem that afflicts 15% to 20% of women in the United States. Although more than 200,000 hysterectomies are performed annually for the treatment of chronic pelvic pain, previous studies indicate that 1 in 4 women undergo the discomfort and morbidity of hysterectomy without the relief of pain. The factors that predict treatment failure remain poorly characterized.

Objective

To describe the incidence of persistent pelvic pain 6 months following hysterectomy in women with chronic pelvic pain and determine whether a simple, self-reported measure of central sensitization is associated with a greater risk of persistent pelvic pain following hysterectomy.

Study Design

We conducted a prospective, observational cohort study of women undergoing hysterectomy at an academic tertiary care center for a benign indication. Patients with preoperative chronic pelvic pain, defined as average pelvic pain ≥3 on a 0 to 10 numeric rating scale for >3 months before hysterectomy, were included in this analysis. The 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. The demographic information, surgical history, intraoperative findings, and surgical pathology were abstracted from the electronic medical records. Multivariate logistic regression was used to identify the independent predictors of persistent pelvic pain 6 months following hysterectomy, defined as <50% improvement in pelvic pain severity.

Results

Among 176 participants with pelvic pain before hysterectomy, 126 (71.6%) were retained at 6 months, and 15 (11.9%) reported persistent pelvic pain. There was no difference in age (P=.46), race (P=.55), average pain severity during menses (P=.68), average overall pelvic pain (P=.10), or pain duration (P=.80) in those with and without persistent pelvic pain. Whereas intraoperative findings of endometriosis (P=.05) and uterine fibroids (P=.03) were associated with a higher incidence of persistent pain on univariate analysis, the surgical route (P=.46), pelvic adhesions (0.51), uterine weight (P=.66), and adenomyosis on histopathology (P=.27) were not related to the risk of persistent pain. Higher preoperative centralized pain scores (P=.01) but not depression (P=.64) or anxiety (P=.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 before hysterectomy was associated with a 27% increase in the odds of persistent pelvic pain (odds ratio, 1.27; 95% confidence interval, 1.03–1.57) 6 months after surgery.

Conclusion

Although the majority of women with chronic pelvic pain report considerable improvement in pain following hysterectomy, higher degrees of centralized pain before hysterectomy is a robust predictor of persistent pelvic pain.

中文翻译：

---

慢性盆腔痛女性子宫切除术后持续盆腔疼痛的发生率和预测因素

背景

慢性盆腔疼痛是一个令人衰弱的问题，困扰着美国 15% 到 20% 的女性。尽管每年有超过 200,000 例子宫切除术用于治疗慢性盆腔疼痛，但先前的研究表明，四分之一的女性在没有缓解疼痛的情况下经历了子宫切除术的不适和并发症。预测治疗失败的因素仍然缺乏特征。

客观的

描述慢性盆腔疼痛女性子宫切除术后 6 个月持续性盆腔疼痛的发生率，并确定简单的、自我报告的中枢致敏性测量是否与子宫切除术后持续性盆腔疼痛的风险增加有关。

学习规划

我们对在一家学术三级医疗中心接受子宫切除术的女性进行了一项前瞻性观察性队列研究，研究对象是良性适应症。本分析包括术前慢性盆腔疼痛的患者，定义为子宫切除术前 3 个月以上 0 至 10 数字评分量表中平均盆腔疼痛≥3 的患者。患者在术前和子宫切除术后 6 个月完成了对疼痛、焦虑、抑郁和集中性疼痛的有效评估（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学。多变量逻辑回归用于确定子宫切除术后 6 个月持续性盆腔疼痛的独立预测因子，定义为 <

结果

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%）报告持续性盆腔疼痛。年龄 ( P =.46)、种族 ( P =.55)、月经期间的平均疼痛严重程度 ( P =.68)、平均整体盆腔疼痛 ( P =.10) 或疼痛持续时间 ( P = .80) 在有或没有持续性骨盆疼痛的人中。而在单变量分析中，子宫内膜异位症 ( P =.05) 和子宫肌瘤 ( P =.03) 的术中发现与持续性疼痛的发生率较高相关，手术路径 ( P =.46)、盆腔粘连 (0.51)、子宫重量（P=.66）和组织病理学上的子宫腺肌病（P =.27）与持续性疼痛的风险无关。较高的术前集中疼痛评分 ( P =.01) 但抑郁症 ( P =.64) 或焦虑症 ( P =.45) 在持续性盆腔疼痛的女性中更为常见。调整年龄、术前疼痛严重程度、焦虑、抑郁以及子宫内膜异位症和子宫肌瘤的手术结果的多变量逻辑回归表明，子宫切除术前集中性疼痛每增加 1 点与持续性盆腔疼痛的几率增加 27% 相关（几率比率，1.27；95% 置信区间，1.03–1.57) 术后 6 个月。

结论

尽管大多数患有慢性盆腔疼痛的女性报告说子宫切除术后疼痛有显着改善，但子宫切除前较高程度的集中性疼痛是持续性盆腔疼痛的有力预测因素。