{"paper_id":"d30ea6aa-cf9d-453f-b8fc-cadeb531b2f4","body_text":"- Library Home /\n- Search Collections /\n- Open Collections /\n- Browse Collections /\n- UBC Faculty Research and Publications /\n- Pelvic Pain Comorbidities Associated with Quality-of-life...\nOpen Collections\nUBC Faculty Research and Publications\nPelvic Pain Comorbidities Associated with Quality-of-life after Endometriosis Surgery Tucker, Dwayne; Noga, Heather; Lee, Caroline E.; Chiu, Derek S.; Bedaiwy, Mohamed Ali, 1968-; Williams, Christina; Allaire, Catherine; Talhouk, Aline; Yong, Paul J.\nAbstract\nBackground: After endometriosis surgery, pain can persist or recur in a subset of\npatients. A possible reason for persistent pain post-surgery is central nervous system\nsensitization and associated pelvic pain comorbidities. Surgery addresses the\nperipheral component of endometriosis pain pathophysiology (by lesion removal) but\nmay not treat this centralized pain. Therefore endometriosis patients with pelvic pain\ncomorbidities related to central sensitization may experience worse pain-related\noutcomes after surgery, such as lower pain-related quality-of-life.\nObjective: To determine whether baseline (preoperative) pelvic pain comorbidities are\nassociated with pain-related quality-of-life at follow-up after endometriosis surgery.\nStudy Design: This study utilized longitudinal prospective registry data from the\nEndometriosis and Pelvic Pain Interdisciplinary Cohort at the BC Women’s Center for\nPelvic Pain and Endometriosis. Subjects were ≤ 50 years old with confirmed or\nclinically suspected endometriosis, who underwent surgery (fertility-sparing or\nhysterectomy) for endometriosis pain. Subjects completed the pain subscale of the\nEndometriosis Health Profile (EHP-30) quality-of-life questionnaire preoperatively and\nat follow-up (1-2 years). Linear regression was performed to measure the individual\nrelationships between seven pelvic pain comorbidities at baseline and follow-up EHP-\n30 score, controlling for baseline EHP-30 and type of surgery received. These baseline\n(preoperative) pelvic pain comorbidities included abdominal wall pain, pelvic floor\nmyalgia, painful bladder syndrome, irritable bowel syndrome, Patient Health\nQuestionnaire (PHQ-9) depression score, General Anxiety Disorder (GAD-7) score,\nand Pain Catastrophizing Scale (PCS) score. LASSO regression was then performed\nto select the most important variables associated with follow-up EHP-30 from among\nseventeen covariates (including the seven pelvic pain comorbidities, baseline EHP-30\nscore, type of surgery, and other endometriosis-related factors such as stage and\nhistologic confirmation of endometriosis). Using 1000 bootstrap samples, we estimated\nthe coefficients and confidence intervals of the selected variables and generated a\ncovariate importance rank. Results: The study included 444 subjects. The median follow-up time was 18 months.\nPain-related quality-of-life (EHP-30) of the study population significantly improved at\nfollow-up after surgery (p<0.001). The following pelvic pain comorbidities were\nassociated with lower quality-of-life (higher EHP-30 score) after surgery controlling for\nbaseline EHP-30 score and type of surgery (fertility-sparing vs. hysterectomy):\nabdominal wall pain (p=0.013), pelvic floor myalgia (p=0.036), painful bladder\nsyndrome (p=0.022), PHQ-9 score (p<0.001), GAD-7 score (p<0.001), and PCS score\n(p=0.007). Irritable bowel syndrome was not significant (p=0.70). Of the seventeen\ncovariates included for LASSO regression, six remained in the final model (lambda =\n3.136). These included three pelvic pain comorbidities that were associated with higher\nfollow-up EHP-30 scores or worse quality-of-life: abdominal wall pain (β = 3.19), pelvic\nfloor myalgia (β = 2.44), and PHQ-9 depression score (β = 0.49). The other three\nvariables in the final model were baseline EHP-30 score, type of surgery, and\nhistologic confirmation of endometriosis.\nConclusion: Pelvic pain comorbidities present at baseline before surgery, which may\nreflect underlying central nervous system sensitization, are associated with lower pain related\nquality-of-life after endometriosis surgery. Particularly important were\ndepression and musculoskeletal/myofascial pain (abdominal wall pain and pelvic floor\nmyalgia). Therefore, these pelvic pain comorbidities should be candidates for a formal\nprediction model of pain outcomes after endometriosis surgery.\nItem Metadata\n| Title |\nPelvic Pain Comorbidities Associated with Quality-of-life after Endometriosis Surgery\n|\n| Creator | |\n| Contributor | |\n| Publisher |\nElsevier\n|\n| Date Issued |\n2023-05-04\n|\n| Description |\nBackground: After endometriosis surgery, pain can persist or recur in a subset of\npatients. A possible reason for persistent pain post-surgery is central nervous system\nsensitization and associated pelvic pain comorbidities. Surgery addresses the\nperipheral component of endometriosis pain pathophysiology (by lesion removal) but\nmay not treat this centralized pain. Therefore endometriosis patients with pelvic pain\ncomorbidities related to central sensitization may experience worse pain-related\noutcomes after surgery, such as lower pain-related quality-of-life.\nObjective: To determine whether baseline (preoperative) pelvic pain comorbidities are\nassociated with pain-related quality-of-life at follow-up after endometriosis surgery.\nStudy Design: This study utilized longitudinal prospective registry data from the\nEndometriosis and Pelvic Pain Interdisciplinary Cohort at the BC Women’s Center for\nPelvic Pain and Endometriosis. Subjects were ≤ 50 years old with confirmed or\nclinically suspected endometriosis, who underwent surgery (fertility-sparing or\nhysterectomy) for endometriosis pain. Subjects completed the pain subscale of the\nEndometriosis Health Profile (EHP-30) quality-of-life questionnaire preoperatively and\nat follow-up (1-2 years). Linear regression was performed to measure the individual\nrelationships between seven pelvic pain comorbidities at baseline and follow-up EHP-\n30 score, controlling for baseline EHP-30 and type of surgery received. These baseline\n(preoperative) pelvic pain comorbidities included abdominal wall pain, pelvic floor\nmyalgia, painful bladder syndrome, irritable bowel syndrome, Patient Health\nQuestionnaire (PHQ-9) depression score, General Anxiety Disorder (GAD-7) score,\nand Pain Catastrophizing Scale (PCS) score. LASSO regression was then performed\nto select the most important variables associated with follow-up EHP-30 from among\nseventeen covariates (including the seven pelvic pain comorbidities, baseline EHP-30\nscore, type of surgery, and other endometriosis-related factors such as stage and\nhistologic confirmation of endometriosis). Using 1000 bootstrap samples, we estimated\nthe coefficients and confidence intervals of the selected variables and generated a\ncovariate importance rank. Results: The study included 444 subjects. The median follow-up time was 18 months.\nPain-related quality-of-life (EHP-30) of the study population significantly improved at\nfollow-up after surgery (p<0.001). The following pelvic pain comorbidities were\nassociated with lower quality-of-life (higher EHP-30 score) after surgery controlling for\nbaseline EHP-30 score and type of surgery (fertility-sparing vs. hysterectomy):\nabdominal wall pain (p=0.013), pelvic floor myalgia (p=0.036), painful bladder\nsyndrome (p=0.022), PHQ-9 score (p<0.001), GAD-7 score (p<0.001), and PCS score\n(p=0.007). Irritable bowel syndrome was not significant (p=0.70). Of the seventeen\ncovariates included for LASSO regression, six remained in the final model (lambda =\n3.136). These included three pelvic pain comorbidities that were associated with higher\nfollow-up EHP-30 scores or worse quality-of-life: abdominal wall pain (β = 3.19), pelvic\nfloor myalgia (β = 2.44), and PHQ-9 depression score (β = 0.49). The other three\nvariables in the final model were baseline EHP-30 score, type of surgery, and\nhistologic confirmation of endometriosis.\nConclusion: Pelvic pain comorbidities present at baseline before surgery, which may\nreflect underlying central nervous system sensitization, are associated with lower pain related\nquality-of-life after endometriosis surgery. Particularly important were\ndepression and musculoskeletal/myofascial pain (abdominal wall pain and pelvic floor\nmyalgia). Therefore, these pelvic pain comorbidities should be candidates for a formal\nprediction model of pain outcomes after endometriosis surgery.\n|\n| Subject | |\n| Genre | |\n| Type | |\n| Language |\neng\n|\n| Date Available |\n2024-05-04\n|\n| Provider |\nVancouver : University of British Columbia Library\n|\n| Rights |\nAttribution-NonCommercial-NoDerivatives 4.0 International\n|\n| DOI |\n10.14288/1.0433736\n|\n| URI | |\n| Affiliation | |\n| Citation |\nDwayne R. Tucker, Heather L. Noga, Caroline Lee, Derek S. Chiu, Mohamed A. Bedaiwy, Christina Williams, Catherine Allaire, Aline Talhouk, Paul J. Yong, Pelvic pain comorbidities associated with quality of life after endometriosis surgery, American Journal of Obstetrics and Gynecology, 2023\n|\n| Publisher DOI |\n10.1016/j.ajog.2023.04.040\n|\n| Peer Review Status |\nReviewed\n|\n| Scholarly Level |\nFaculty; Graduate\n|\n| Rights URI | |\n| Aggregated Source Repository |\nDSpace\n|\nItem Media\nItem Citations and Data\nRights\nAttribution-NonCommercial-NoDerivatives 4.0 International","source_license":"CC0","license_restricted":false}