The Impact of Central Sensitization on Patients Perceived Improvement and Quality of Life Following Surgery for Chronic Pelvic Pain: A Pilot Study

STUDY OBJECTIVE: To assess whether higher baseline Central Sensitization Inventory (CSI) scores are linked to quality-of-life outcomes and patient's impression of improvement after surgery for chronic pelvic pain. DESIGN: Prospective observational study. SETTING: Large academic health system. PATIENTS OR PARTICIPANTS: Women aged 18 to 55 with chronic pelvic pain and suspected endometriosis scheduled for endometriosis excision surgery. INTERVENTIONS: Participants completed the CSI and Endometriosis Health Profile (EHP-30) surveys preoperatively to assess baseline central sensitization and health related quality of life. Patients completed the Patient Global Impression of Improvement (PGI-I) questionnaire and repeated CSI and EHP-30 surveys 3 months postoperatively. Data were analyzed using counts, percentages, medians, interquartile ranges, and Spearman's correlation coefficient (p <.05 for significance). MEASUREMENT AND PRIMARY RESULTS: Of 97 enrolled patients, 66 (68%) completed both pre- and postoperative surveys. A positive relationship was found between preoperative CSI scores and postoperative PGI-I (r = 0.25, p = .04), indicating less improvement with higher CSI scores. Similarly, a moderate positive correlation was seen between preoperative CSI and postoperative EHP-30 (r = 0.52, p <.01), suggesting poorer quality of life after surgery in patients with central sensitization. Higher preoperative CSI scores also correlated with higher postoperative pain scores (r = 0.42, p <.01). Patients were divided into "improved" (PGI-I<4) and "not improved/worsened" (PGI-I≥4) groups. The improved group had significantly lower postoperative EHP-30 scores indicating improved quality of life, and lower pain-specific scores compared to the non-improved group (p <.01). CONCLUSIONS: Patients with central sensitization are less likely to experience significant postoperative improvements in pain and quality of life. These findings emphasize the importance of considering central sensitization in preoperative counseling to set realistic expectations for surgery outcomes and identify patients at risk of persistent pain and poor quality of life.