Endometriosis in Patients with Chronic Pelvic Pain: Is Staging Predictive of the Efficacy of Laparoscopic Surgery in Pain Relief?

Spyros Milingos, Αθανάσιος Πρωτόπαπας, Athanasios Protopapas, George Kallipolitis, Petros Drakakis, Dimitrios Loutradis, Anthoula Liapi, Aris Antsaklis
Gynecologic and obstetric investigation · 2006 · vol. 62(1) , pp. 48–54 · doi:10.1159/000092023 · PMID:16543749 · W2052507168
article OA: closed CC0 ⤵ 39 in-corpus citations
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Advanced endometriosis stages correlate with more severe dysmenorrhea and deep dyspareunia, and laparoscopic surgery shows greater pain relief for advanced disease.

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Abstract

BACKGROUND/AIMS: Endometriosis is considered an important cause of chronic pelvic pain. Despite its high prevalence, controversy still exists regarding the true association between the extent of endometriosis and the severity of symptoms. We conducted this prospective study to investigate the association between the stage of endometriosis and type and severity of pain, and to evaluate the efficacy of laparoscopic surgery in pain relief. METHODS: Ninety-five patients complaining of chronic pain were diagnosed with endometriosis and were treated with laparoscopic surgery. The severity of pain was assessed in patients with an endometriosis AFS (American Fertility Society) score less than 16 (group 1) and those with an AFS score greater than or equal to 16 (group 2), preoperatively and 6 months after surgery, using a visual pain scale. Any reduction in pain scores by 2 points or more was considered to be an improvement. RESULTS: Dysmenorrhea and deep dyspareunia, were significantly more frequent in patients of group 2. Preoperative pain scores were significantly higher for dysmenorrhea (p = 0.0022) and deep dyspareunia (p < 0.0001) but not for non-menstrual pain in group 2. Deep dyspareunia was correlated with the presence of dense pelvic adhesions. After surgery, dysmenorrhea improved in 43% of cases in group 1, vs. 66% of cases in group 2 (p = 0.0037). For deep dyspareunia, improvement was reported by 33% in group 1, vs. 67% in group 2 (p = 0.074). Improvement in non-menstrual pain was not significantly different between the two groups (67% vs. 56%). CONCLUSIONS: Advanced endometriosis is more frequently related to dysmenorrhea and deep dypareunia in comparison to early disease. Laparoscopic surgery may offer relief or improvement in the majority of patients with endometriosis and chronic pelvic pain. Cases with advanced disease seem to benefit the most.

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Condition tags

mesh:D004412mesh:D004414mesh:D004715mesh:D017699endometriosischronic_pelvic_paindysmenorrheadyspareunia

MeSH descriptors

Endometriosis Endometriosis Laparoscopy Pelvic Pain Chronic Disease Dysmenorrhea Dysmenorrhea Dysmenorrhea Dyspareunia Dyspareunia Dyspareunia Endometriosis Endometriosis Endometriosis Female Humans Pain Measurement Pelvic Pain Prospective Studies Treatment Outcome

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References (34)

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