Prediction of postoperative pain after gynecologic laparoscopy for nonacute pelvic pain

John Jarrell, Sue Ross, Magali Robert, Stephen Wood, Selphee Tang, Kirk Stephanson, Maria Adele Giamberardino
American journal of obstetrics and gynecology · 2014 · vol. 211(4) , pp. 360.e1–360.e8 · doi:10.1016/j.ajog.2014.04.010 · PMID:24732001 · W2082956393
Non-randomised trial OA: closed CC0 ⤵ 13 in-corpus citations
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This study aimed to predict postoperative pain following gynecologic laparoscopy for nonacute pelvic pain.

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Abstract

OBJECTIVE: The primary objectives of this study were to explore the pain experience after gynecologic laparoscopy that is performed for nonacute pain conditions and to determine whether preoperative psychologic tests and quantitative tests of sensitization can predict postoperative pain. STUDY DESIGN: Participants included 61 women who underwent laparoscopy for nonacute pain (n = 61). A second group of 16 women who had undergone tubal ligation was included to explore whether laparoscopy induced a painful postoperative response in women without preoperative pain. Subjective tests included numeric pain scale, pain catastrophizing scale, depression scale, global assessment of change, and the McGill Pain Questionnaire Short Form. Quantitative sensory testing included abdominal cutaneous allodynia, trigger points, and reduced pain thresholds. The nonacute pain sample had 80% power to detect a difference of 0.5 standard deviation in average pain levels. Analysis included parametric and nonparametric comparisons of groups and univariate and linear regression analysis of clinically relevant variables. RESULTS: In women who underwent tubal ligation, pain levels were low before and after the procedure. In women who underwent surgery for nonacute pain, pain levels at 6 months and all psychologic test scores were reduced significantly compared with baseline (P < .001 and P = .001, respectively). Among those women with positive results on the quantitative pain tests of sensitization at baseline, average postoperative pain was also significantly reduced (P < .001). Univariate analysis demonstrated only tests of sensitization that were correlated with change in average pain level (P = .01). Regression analysis suggested that baseline pain, catastrophizing, and the presence of cutaneous allodynia significantly predicted pain levels 6 months after surgery (P < .001). CONCLUSION: Pain after laparoscopic surgery for nonacute painful conditions can be predicted by baseline pain, catastrophizing, and the presence of allodynia, which is a simple swab test that indicates sensitization.

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MeSH descriptors

Laparoscopy Pelvic Pain Postoperative Pain Adolescent Adult Case-Control Studies Catastrophization Depression Depression Female Humans Hyperalgesia Hyperalgesia Hyperalgesia Linear Models Middle Aged Pain Measurement Pain Threshold Pelvic Pain Pelvic Pain

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