McGill Pain Questionnaire: A multi-dimensional verbal scale assessing postoperative changes in pain symptoms associated with severe endometriosis (original) (raw)
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Reproduction and Fertility, 2021
Background Up to 28% of endometriosis patients do not get pain relief from therapeutic laparoscopy but this subgroup is not defined. Objectives To identify any prognostic patient-specific factors (such as but not limited to patients’ type or location of endometriosis, sociodemographics and lifestyle) associated with a clinically meaningful reduction in post-surgical pain response to operative laparoscopic surgery for endometriosis. Search strategy PubMed, Cochrane and Embase databases were searched from inception to 19 May 2020 without language restrictions. Backward and forward citation tracking was used. Selection criteria, data collection and analysis: Cohort studies reporting prognostic factors, along with scores for domains of pain associated with endometriosis before and after surgery, were included. Studies that compared surgeries, or laboratory tests, or outcomes without stratification were excluded. Results were synthesised but variation in study designs and inconsistency o...
Women's Pain Experience Predicts Future Surgery for Pain Associated With Endometriosis
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2007
A previous randomized controlled trial from 1991 to 1993 comparing excision of endometriosis with sham surgery demonstrated no difference in reported pain after blinding between the excision and sham groups for one year. Overall, when both groups were considered, there was a significant reduction in pain one year postoperatively. This trial was done to determine the predictors of subsequent surgery. The time to repeat surgery was the outcome of interest as a marker for significant pain. Survival analysis and log rank tests were performed to determine if the time to repeat surgery differed by group or by age, parity, original level of pain pre-operatively and stage of the disease. Only the reported measurement of pain prior to the initial trial was a significant covariate in the overall prediction of repeat surgery among all subjects. The overall repeat surgical operation rate was 48.3% in the sham surgery group and 51.7% in the excision group. The estimated relative risk for repeat ...
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2011
To investigate factors that might influence the recurrence of both painful symptoms and endometriotic lesions following laparoscopic treatment of endometriosis. Study design: Retrospective cohort study in a University teaching hospital. We reviewed data from patients referred for laparoscopy between March 1993 and November 2007. We selected women who were followed up throughout Transvaginal-ultrasound (TV-US) after a first conservative laparoscopy for endometriosis. After laparoscopy, all patients were followed up according to an internal protocol: a standard gynaecologic examination, the assessment of painful symptoms and a TV-US scan that were repeated at 3, 6, and 12 months, and subsequently on a yearly basis. Sixteen factors were assessed by univariable and multivariable Cox proportional hazards models to evaluate their associations with recurrence of endometriotic lesions and pain related-endometriosis. Results: 401 women were enrolled. A total of 154 (38.4%) experienced moderate or severe pain after laparoscopy; endometriotic lesions were observed by TV-US in 74 (18.4%) patients. In the multivariable model, age at menarche, severity of chronic pelvic pain (CPP) and dysmenorrhoea prior to surgery were significant risk factors for recurrence/occurrence of pain. Age at the first laparoscopy, stage of disease, pre-operative severity of CPP, and pregnancy were predictive factors of the recurrence for such lesions. Conclusion: The severity of CPP prior to the first laparoscopy showed the only significant factor in the overall prediction of recurrence of pain and endometriotic lesions. Patients with severe CPP at the time of their first surgery might represent a subgroup of women with a more aggressive form of endometriosis.
Postoperative Pain Survival and Correlating Factors in Endometriosis Patients
Indonesian Journal of Obstetrics and Gynecology, 2019
Objective: To determine the survival of pain complaints at 3, 6, 9 and 12 months and the correlation between age at diagnosis, age of menarche, parity, stage of disease and post-operative medication in endometriosis patient at RSUPN Dr. Cipto Mangunkusumo. Methods: This was a prospective cohort study with survival analysis method of 139 women of productive age with endometriosis who came to Gynecology Outpatient Clinic in Dr. Cipto Mangunkusumo Hospital from January 2015 to January 2017. The patients were observed at 3 months, 6 months, 9 months and 12 months after the surgery. Results: Survival of pain complaints at 3, 6, 9 and 12 months after endometriosis operation was 99.2%, 96.6%, 93% and 88.4% respectively. There was no significant correlation between post-operative pain survival and age of diagnosis (p=0.138), age of menarche (p=0.492), parity (p=0.110) and stage of disease (p=0.908). There was a significant correlation between post-operative medical therapy and pain complain...
2021
BackgroundChronic pelvic pain (CPP) is a common condition which significantly impacts the quality of life and wellbeing of many women.Laparoscopy with histopathology is recommended for investigation of pelvic pain and identification of endometriosis with concurrent removal. Never-the-less, the association between endometriosis and pelvic pain is challenging, with endometriosis identified in only 30-50% of women with pain.AimsTo explore the predictors for undergoing surgery, for identifying endometriosis and endometriosis severity in a cohort of women with CPP.Materials and MethodsThis study forms part of the Persistent Pelvic Pain project, a prospective observational cohort study (ANZCTR:ACTRN12616000150448). Women referred to a public gynaecology clinic with pain were randomised to one of 2 gynaecology units for routine care and followed for 36-months with 6-monthly surveys assessing demographics, medical history, quality of life, and pain symptoms measured on a Likert scale. Opera...
Hamidiye Medical Journal
Amaç: Bu çalışmada izole endometrioma tanısı konan hastalarda laparoskopik cerrahinin postoperatif dönemde görsel analog skala (VAS) ile değerlendirilerek dismenore, pelvik ağrı, disparoni ve abdominal distansiyonun preoperatif döneme göre azaltıp azaltmadığı araştırıldı. Gereç ve Yöntemler: 2017 ve 2020 yılları arasında pelvik ağrı şikayetiyle başvuran ve endometrioma tanısı ile laparoskopik cerrahi uygulanan 197 hastanın arasından izole endometrioma tespit edilen 36 olgunun preoperatif ve postoperatif VAS skorları karşılaştırıldı. Hastalardan ameliyat öncesi ve sonrası endometriozis ile ilişkili ağrının (dismenore, pelvik ağrı, disparoni ve abdominal distansiyon) dört bileşenini içeren 100 mm'lik bir VAS ölçeğini içeren bir anketi doldurmaları istendi. Derin infiltratif endometriozis, peritoneal endometriozis ve buna bağlı ciddi intraoperatif adezyonları bulunan, daha önce endometriozis cerrahisi geçirenler, operasyondan önce endometriozis veya endometrioma nedeniyle hormonal tedavi alan hastalar çalışma dışında tutuldu. Bulgular: Hastaların siklik-non-siklik pelvik ağrı, dismenore, disparoni ve abdominal distansiyon VAS skorlarında preoperatif döneme kıyasla postoperatif dönemde anlamlı düzeyde azalma olduğu izlendi (p<0,05). ÖZ Background: In this study, it was investigated whether laparoscopic surgery reduces dysmenorrhea, pelvic pain, dyspareunia and abdominal distension evaluated with visual analog scale (VAS) in the postoperative period compared to the preoperative period in patients diagnosed with isolated endometrioma. Materials and Methods: The preoperative and postoperative VAS scores of 36 cases with isolated endometrioma were compared among 197 patients who applied with pelvic pain and underwent laparoscopic surgery with an endometrioma diagnosis between 2017 and 2020. Patients were asked to complete a questionnaire containing a 100 mm VAS scale that included the four components of pre-and post-operative endometriosis-related pain (dysmenorrhea, pelvic pain, dyspareunia, and abdominal distension). Patients with deep infiltrative endometriosis, peritoneal endometriosis, related severe intraoperative adhesions, those who had previously undergone endometriosis surgery, and those who had received hormonal therapy for endometriosis or endometrioma before the surgery were found to be excluded from the study. Results: The VAS scores of the patients for cyclic-non-cyclic pelvic pain, dysmenorrhea, dyspareunia, and abdominal distension decreased significantly in the postoperative period compared to the preoperative period (p<0.05). Conclusion: This study determined that the symptoms of cyclic-non-cyclic pelvic pain, dysmenorrhea, dyspareunia, and abdominal distension after laparoscopic surgery in patients with isolated endometrioma were significantly reduced compared to the period before surgery. In addition, CA-125 biomarker results were significantly reduced after laparoscopic surgery in patients with isolated endometrioma.
Pain typology and incident endometriosis
Human Reproduction, 2015
study question: What are the pain characteristics among women, with no prior endometriosis diagnosis, undergoing laparoscopy or laparotomy regardless of clinical indication? summary answer: Women with surgically visualized endometriosis reported the highest chronic/cyclic pain and significantly greater dyspareunia, dysmenorrhea, and dyschezia compared with women with other gynecologic pathology (including uterine fibroids, pelvic adhesions, benign ovarian cysts, neoplasms and congenital Müllerian anomalies) or a normal pelvis. what is known already: Prior research has shown that various treatments for pain associated with endometriosis can be effective, making identification of specific pain characteristics in relation to endometriosis necessary for informing disease diagnosis and management. study design, size, duration: The study population for these analyses includes the ENDO Study (2007-2009) operative cohort: 473 women, ages 18-44 years, who underwent a diagnostic and/or therapeutic laparoscopy or laparotomy at one of 14 surgical centers located in Salt Lake City, UT or San Francisco, CA. Women with a history of surgically confirmed endometriosis were excluded. participants/materials, setting and methods: Endometriosis was defined as surgically visualized disease; staging was based on revised American Society for Reproductive Medicine (rASRM) criteria. All women completed a computer-assisted personal interview at baseline specifying 17 types of pain (rating severity via 11-point visual analog scale) and identifying any of 35 perineal and 60 full-body front and 60 full-body back sites for which they experienced pain in the last 6 months. main results and the role of chance: There was a high prevalence (≥30%) of chronic and cyclic pelvic pain reported by the entire study cohort regardless of post-operative diagnosis. However, women with a post-operative endometriosis diagnosis, compared with women diagnosed with other gynecologic disorders or a normal pelvis, reported more cyclic pelvic pain (49.5% versus 31.0% and 33.1%, P , 0.001). Additionally, women with endometriosis compared with women with a normal pelvis experienced more chronic pain (44.2 versus 30.2%, P ¼ 0.04). Deep pain with intercourse, cramping with periods, and pain with bowel elimination were much more likely reported in women with versus without endometriosis (all P , 0.002). A higher percentage of women diagnosed with endometriosis compared with women with a normal pelvis reported vaginal (22.6 versus 10.3%, P , 0.01), right labial (18.4 versus 8.1%, P , 0.05) and left labial pain (15.3 versus 3.7%, P , 0.01) along with pain in the right/left hypogastric and umbilical abdominopelvic regions (P , 0.05 for all). Among women with endometriosis, no clear and consistent patterns emerged regarding pain characteristics and endometriosis staging or anatomic location. limitations, reasons for caution: Interpretation of our findings requires caution given that we were limited in our assessment of pain characteristics by endometriosis staging and anatomic location due to the majority of women having minimal (stage I) disease (56%) and lesions in peritoneum-only location (51%). Significance tests for pain topology related to gynecologic pathology were not corrected for multiple comparisons. wider implications of the findings: Results of our research suggest that while women with endometriosis appear to have higher pelvic pain, particularly dyspareunia, dysmenorrhea, dyschezia and pain in the vaginal and abdominopelvic area than women with other gynecologic disorders or a normal pelvis, pelvic pain is commonly reported among women undergoing laparoscopy, even among women with no
BioMed research international, 2017
To evaluate influences of various factors on the types and intensity of postoperative pain following gynecologic laparoscopic surgery. Cross-sectional questionnaire and chart review. A total of 84 questionnaires were distributed and returned. The types of postlaparoscopic pain are different in multiparous women and nulliparous ones (71.43% surgical wound pain versus 63.64% nonsurgical wound pain, = 0.0033) and those with striae gravidarum and without striae gravidarum (93.94% surgical wound pain versus 52.94% nonsurgical wound pain, < 0.0001). On postoperative day 1, the average VAS score is higher in nonsurgical wound pain than in surgical wound pain (5.62 ± 1.50 versus 3.51 ± 1.68, < 0.0001). The CO removal procedure has a significant negative correlation with the VAS of nonsurgical wound pain (coefficient: -0.4339, = 0.0187). Our study suggests that women with abdominal rigidity (nulliparous, no striae gravidarum) experience mainly nonsurgical wound pain, while women with a...
evaluated the laparoscopic surgery results for CPP, the anathomo-pathological exams and the CPP protocol filled up during appointments before laparoscopy. Results: Thirty-six patients were submitted to laparoscopy. Fifty percent of the patients reported cyclical pain and ninety five percent of the patients had dysmenorrheal and dyspareunia complaint. History of Sexually Transmitted Disease (STD) or PID was present in 43% and 48% of the cases, respectively. The most common contraceptive method used was oral contraceptive by 55,6% of the patients, followed by tubal ligation and condoms , both with 11% rate. Anamnesis revealed 8,3% of obesity, 22% of tobacco users and 6% suffer from depression. Almost half of the patients revealed familial history of endometriosis (47%), wherein 37% of patients with endometriosis diagnosis from laparoscopy had a positive familial history of the disease. Physical examination revealed abdominal scar in 53% of the patients, pain during palpation in 67%, and pain at uterine cervix mobilization in 80%. At laparoscopy we observed high prevalence of endometriosis as a cause of Chronic Pelvic Pain (58,3%). From all patients with endometriosis diagnosis, 50% were classified as stage I, and 50% as stage IV. Discussion: More than a half of the patients with CPP presented endometriosis diagnosis. We observed an expressive percentage of patients with mild endometriosis. In these cases pain could be justified by the production of local inflammatory factors in atypical lesions that are active biologically. In accordance with the literature there is no correlation between pain due to endometriosis and the stage of the disease.