Persistent posthysterectomy pain A prospective, observational study

BACKGROUNDThere is a large variation in the prevalence of persistent postsurgical pain depending on the type of surgery. It is unclear how common persistent postsurgical pain is after vaginal or laparoscopic hysterectomy.OBJECTIVESThe objective of this study was to define the prevalence of persistent postsurgical pain 6 months after laparoscopic or vaginal hysterectomy for benign causes and to ascertain the intensity of the pain and its possible predictors.DESINGA prospective, observational study.SETTINGPirkanmaa Hospital District between October 2008 and September 2013.PATIENTSTwo hundred and forty-two women who underwent laparoscopic (150) or vaginal (92) hysterectomy for benign causes and who also participated in our earlier studies concerning acute pain.INTERVENTIONSA pain questionnaire and a prestamped return envelope were mailed to all women 6 months after surgery. If the questionnaire had not been returned within 4 weeks, a reminder was sent. Data regarding preoperative pain and acute postoperative pain were collected from the records of our earlier studies concerning acute pain. The patient characteristics and surgical outcomes were collected from the patients' medical records.MAIN OUTCOME MEASUREThe prevalence of persistent postsurgical pain 6 months after hysterectomy.RESULTSThe response rate was 94% (227 respondents). Twenty-seven (18.9%) of 143 patients who had no pain preoperatively had persistent pain after surgery. Overall, 26.0% of patients had persistent pelvic pain 6 months after surgery. On an 11-point numeric rating scale (NRS), most of the patients rated their average pain as mild (NRS 0 to 3) and only 6.9% rated their worst pain as severe (NRS 7 to 10). Smoking, acute postoperative pain at 4h after surgery and a laparoscopic approach were significantly associated with persistent pain in a multivariable analysis.CONCLUSIONPersistent posthysterectomy pain is common, but pain is mild and does not interfere with daily activities for most of the patients 6 months after surgery. Smoking is the strongest predictor for persistent pain.TRIAL REGISTRATIONclinicaltrials.gov Identifier: NCT 01537731.