The psychological effects of laparoscopy on women with chronic pelvic pain

Selena Elcombe, Dennis Gath, A. C. Day
In: Psychological Medicine · 1997 · vol. 27(5) , pp. 1041–1050 · doi:10.1017/s0033291797004868 · PMID:9300510 · W1969133168
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This study found that diagnostic laparoscopy reduced pain in women with chronic pelvic pain, with improvements predicted by beliefs about pain and perceived condition seriousness, suggesting psychological mechanisms are involved.

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This study evaluated the effects of diagnostic laparoscopy on women with chronic pelvic pain and examined psychological mechanisms by randomly allocating 71 participants to different waiting-time groups, with interviews and follow-up assessments at 1 week, 3 months, and 6 months. Pain outcomes were measured using interview-based assessments, diaries, and visual analogue scales, and pain reductions were observed from pre-laparoscopy to post-laparoscopy. Regression analyses showed that beliefs about pain and changes in each woman’s evaluation of the seriousness of her condition predicted pain improvements, while—other than baseline pain—over 40 other exploratory variables did not emerge as predictors. The paper’s conclusions acknowledge the role of psychological mechanisms but are limited to a relatively short follow-up window and to associations observed in this cohort. Relevance to endometriosis: the study addresses chronic pelvic pain and the impact of diagnostic laparoscopy, an area closely connected to evaluating suspected endometriosis and interpreting “negative” laparoscopies, though the paper itself does not explicitly focus on endometriosis.

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Abstract

BACKGROUND: Many women who undergo diagnostic laparoscopy for chronic pelvic pain do not have pelvic pathology. This has led to an interest in psychological factors that might contribute to their experience of pain. This study was designed to evaluate the effects of diagnostic laparoscopy on women with chronic pelvic pain and to explore possible psychological mechanisms. METHODS: Seventy-one women undergoing laparoscopy for chronic pelvic pain were randomly allocated to one of two groups waiting different lengths of time for laparoscopy. Women were interviewed before laparoscopy and were followed up 1 week, 3 months and 6 months afterwards. Pain was assessed with an interview measure, diaries and visual analogue scales. RESULTS: Pain reductions were observed from before to after diagnostic laparoscopy. Regression analysis was used to identify factors which predicted improvements in pain. The hypothesis that psychological factors would predict improvements in pain was confirmed. Pain improvements after laparoscopy were predicted by beliefs about pain and the change in each woman's evaluation of the seriousness of her condition. Other than baseline pain, these psychological variables were the only ones to emerge as predictors of pain change despite exploratory analysis of over 40 other variables. CONCLUSIONS: Diagnostic laparoscopy can have beneficial effects in women with chronic pelvic pain. These effects appear to be the result of psychological mechanisms. Further investigation of these mechanisms could help in the understanding and treatment of women with chronic pelvic pain.
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Published online by Cambridge University Press: 01 September 1997 Background. Many women who undergo diagnostic laparoscopy for chronic pelvic pain do not have pelvic pathology. This has led to an interest in psychological factors that might contribute to their experience of pain. This study was designed to evaluate the effects of diagnostic laparoscopy on women with chronic pelvic pain and to explore possible psychological mechanisms. Methods. Seventy-one women undergoing laparoscopy for chronic pelvic pain were randomly allocated to one of two groups waiting different lengths of time for laparoscopy. Women were interviewed before laparoscopy and were followed up 1 week, 3 months and 6 months afterwards. Pain was assessed with an interview measure, diaries and visual analogue scales. Results. Pain reductions were observed from before to after diagnostic laparoscopy. Regression analysis was used to identify factors which predicted improvements in pain. The hypothesis that psychological factors would predict improvements in pain was confirmed. Pain improvements after laparoscopy were predicted by beliefs about pain and the change in each woman's evaluation of the seriousness of her condition. Other than baseline pain, these psychological variables were the only ones to emerge as predictors of pain change despite exploratory analysis of over 40 other variables. Conclusions. Diagnostic laparoscopy can have beneficial effects in women with chronic pelvic pain. These effects appear to be the result of psychological mechanisms. Further investigation of these mechanisms could help in the understanding and treatment of women with chronic pelvic pain. - Type - Research Article - Information - Copyright - 1997 Cambridge University Press - 24 - Cited by Cited by Crossref Citations Price, Jonathan R 2000. Managing physical symptoms:. Journal of Psychosomatic Research, Vol. 48, Issue. 1, p. 1. Grace, Victoria M. 2000. Pitfalls of the medical paradigm in chronic pelvic pain. Best Practice & Research Clinical Obstetrics & Gynaecology, Vol. 14, Issue. 3, p. 525. Grace, Victoria 2001. Critical Encounters with the Medical Paradigm: Encouraging Dialogue. Feminism & Psychology, Vol. 11, Issue. 3, p. 421. Merkle, W. 2003. Der chronische Beckenbodenschmerz. p. 9. Swank, DJ Swank-Bordewijk, SCG Hop, WCJ van Erp, WFM Janssen, IMC Bonjer, HJ and Jeekel, J 2003. Laparoscopic adhesiolysis in patients with chronic abdominal pain: a blinded randomised controlled multi-centre trial. The Lancet, Vol. 361, Issue. 9365, p. 1247. Wood, Paul L. 2004. Paediatric and Adolescent Gynaecology. p. 359. Slade, Pauline and Cordle, Christine 2005. Psychological aspects of the management of chronic pelvic pain. Current Obstetrics & Gynaecology, Vol. 15, Issue. 5, p. 298. Stones, Will Cheong, Ying C Howard, Fred M Singh, Shipra and Stones, Will 2005. Cochrane Database of Systematic Reviews. Sundarapandian, Vani Shankar, Meena and Konje, Justin C 2006. Chronic pelvic pain: the enigma of gynaecological practice. British Journal of Hospital Medicine, Vol. 67, Issue. 4, p. 192. Stones, R. William Lawrence, Wendy T. and Selfe, Susan A. 2006. Lasting impressions: Influence of the initial hospital consultation for chronic pelvic pain on dimensions of patient satisfaction at follow-up. Journal of Psychosomatic Research, Vol. 60, Issue. 2, p. 163. Garry, Ray 2006. Diagnosis of endometriosis and pelvic pain. Fertility and Sterility, Vol. 86, Issue. 5, p. 1307. Kang, S.-B Chung, H. H. Lee, H.-P Lee, J. Y. and Chang, Y. S. 2007. Impact of diagnostic laparoscopy on the management of chronic pelvic pain. Surgical Endoscopy, Vol. 21, Issue. 6, p. 916. Dalpiaz, Orietta Kerschbaumer, Andrea Mitterberger, Michael Pinggera, Germar Bartsch, Georg and Strasser, Hannes 2008. Chronic pelvic pain in women: still a challenge. BJU International, Vol. 102, Issue. 9, p. 1061. 2009. Handbook of Women's Health. p. 129. Rosenfeld, Jo Ann 2009. Handbook of Women's Health. p. 167. Vercellini, Paolo Somigliana, Edgardo Viganò, Paola Abbiati, Annalisa Barbara, Giussy and Fedele, Luigi 2009. Chronic pelvic pain in women: etiology, pathogenesis and diagnostic approach. Gynecological Endocrinology, Vol. 25, Issue. 3, p. 149. Singh, N. Rashid, M. and Herath, R. P. 2011. How can we reduce negative laparoscopies for pelvic pain?. Journal of Obstetrics and Gynaecology, Vol. 31, Issue. 1, p. 62. Baranowski, Andrew Paul Mandeville, Anna L. Edwards, Sarah Brook, Suzanne Cambitzi, Julia and Cohen, Melissa 2013. Male chronic pelvic pain syndrome and the role of interdisciplinary pain management. World Journal of Urology, Vol. 31, Issue. 4, p. 779. Baranowski, A.P. Lee, J. Price, C. and Hughes, J. 2014. Pelvic pain: a pathway for care developed for both men and women by the British Pain Society. British Journal of Anaesthesia, Vol. 112, Issue. 3, p. 452. Cheong, Ying C Smotra, Grisham and Williams, Amanda C de C 2014. Non-surgical interventions for the management of chronic pelvic pain. Cochrane Database of Systematic Reviews, Vol. 2014, Issue. 3,

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