Assessment of persistent pelvic pain after hysterectomy: Neuropathic or nociceptive?

Cecilie Therese Hagemann, Unni Kirste
In: Scandinavian Journal of Pain · 2016 · vol. 11(1) , pp. 127–129 · doi:10.1016/j.sjpain.2016.01.006 · PMID:28850452 · W2254597406
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This study assessed patients experiencing persistent pelvic pain after hysterectomy, finding that eight out of sixteen patients showed sensory changes, with five likely experiencing neuropathic pain.

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Abstract

In this issue of the Scandinavian Journal of Pain, Satu Pokkinen and coworkers report from a small prospective observational study of patients examined median 30 months after laparoscopic and vaginal hysterectomy for benign conditions in two hospitals in Tampere, Finland [1].The authors included patients who previously had participated in a questionnaire study, where as many as 26% of the responders (59 out of 227) reported pelvic pain 6 months after surgery [2].Those reporting pain were further invited to participate in this clinical follow-up study.However, only 16 patients were willing to be included.The reported post-operative clinical assessment included a gynaecological examination and a sensory examination performed by two different physicians.The gynaecological examination included inspection of the vulva and vagina, as well as a bimanual palpation of the pelvic area.The sensory examination of the lower abdomen/groin and the vulvar/perineal area was then performed by an anaesthesiologist specialised in pain medicine.A cotton stick was first used for assessing dysfunction in the low-threshold mechanoreceptor system (touch).Furthermore, the nociceptors/thermoreceptor system were tested using a special thermal roller instrument, as well as a pin prick with a wooden tooth pick.In each case, the patient was asked to compare from one site to another and rate the change on a numerical rating scale (NRS).The results were drawn on an illustrative sketch.Of the sixteen patients tested, 10 still reported pain in the questionnaire given before the examination.Eight patients had sensory changes (mostly hyperestesia) corresponding to the iliohypogastric, the genitofemoral or the ilioinguinal nerves verified by the different sensory tests performed, and equally distributed after vaginal and laparoscopic hysterectomy.A conclusion of probable neuropathic pain was drawn from five of these patients.Not surprisingly, the women in this cohort scored lower on health related quality of life scores than the average women in Finland.

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