Comparing the Efficacy of Surgery and Medical Therapy for Pain Management in Endometriosis: A Systematic Review and Meta-analysis

Abolfazl Mehdizadehkashi, Chaichian S, Shahla Chaichian, Kabir A, Ali Kabir, Adolfazl Mehdizadehkashi, Mehdizadehkashi A, Rahmani K, Khaled Rahmani, Mehrdad Moghimi, Moghimi M, Moazzami B, Bahram Moazzami
Pain physician · 2017 · vol. 3(20;3) , pp. 185–195 · doi:10.36076/ppj.2017.195 · PMID:28339429 · W2986485951
Systematic review / meta-analysis OA: bronze CC0 ⤵ 28 in-corpus citations
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This systematic review and meta-analysis found no significant difference in pain improvement between surgical and medical endometriosis treatments, with pain relief increasing over time.

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Abstract

BACKGROUND: Pain is considered as one of the main symptoms of endometriosis. The treatment for endometriosis remains controversial. OBJECTIVES: The aim of this study is to compare the effect of medical or surgical treatments for pain-relief in patients with endometriosis. STUDY DESIGN: Systematic review and meta-analysis. SETTING: Published papers about evaluating pain treatment in endometriosis in PubMed, Scopus, and Google Scholar. METHODS: After searching all studies evaluating pain treatment in endometriosis in PubMed, Scopus, and Google Scholar, there were 23 related studies, containing 1,847 patients enrolled in our study. We used a variety of tests: fixed and random effects models, Q Cochrane test and I2 index, Egger and Begg tests, forest and funnel plots, Trim and fill method, and meta-regression in our analysis. RESULTS: There was no statistically significant difference in pain improvement between surgical and medical treatment. Interestingly, pain relief was more prominent longer after treatment. Both clinical trials and cross sectional studies showed higher improvement in pain than cohort studies. High quality studies and lower body mass index (BMI) had a greater effect on pain relief. All studies were heterogeneous, but there was no publication bias. LIMITATIONS: There was a higher probability of risk of bias in blinding, random sequence generation, and selective outcome reporting in clinical trial studies entered in our meta-analysis. CONCLUSIONS: Our results could not demonstrate the preference of each medical or surgical treatment effect for dysmenorrhea in endometriosis. Additional data is required before a standardized medical protocol can be offered, but we believe this study may encourage clinicians to consider a less invasive alternative for treating their patients' chronic pelvic pain in the near future.Key words: Endometriosis, pain, meta-analysis, therapy, disease management.

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Condition tags

endometriosischronic_pelvic_paindysmenorrhea

MeSH descriptors

Endometriosis Endometriosis Pain Management Pelvic Pain Pelvic Pain Clinical Trials as Topic Clinical Trials as Topic Cross-Sectional Studies Cross-Sectional Studies Endometriosis Endometriosis Female Female Humans Humans Pain Management Pain Management Pelvic Pain Pelvic Pain

Citation neighborhood (2-hop)

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

References (55)

Cited by (29)

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