Incidence and association factors for the development of chronic post-hysterectomy pain at 4- and 6-month follow-up: a prospective cohort study

Incidence and association factors for the development of chronic post-hysterectomy pain at 4- and 6-month follow-up: a prospective cohort study

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Ban Leong Sng,1,2 Yin Ying Ching,3 Nian-Lin R Han,4 Farida Trim Binte Ithnin,1 Rehena Sultana,5 Pryseley Nkouibert Assam,6 Alex Tiong Heng Sia1,2 1Department of Women’s Anaesthesia, KK Women’s and Children’s Hospital, Singapore, Singapore; 2Duke-NUS Medical School, Singapore, Singapore; 3Ministry of Health Holdings, Singapore, Singapore; 4Division of Clinical Support Services, KK Women’s and Children’s Hospital, Singapore, Singapore; 5Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore; 6Singapore Clinical Research Institute, Singapore, Singapore Abstract: Chronic pain has major adverse effects on health-related quality of life and contributes to significant socioeconomic burden.Hysterectomy is a very common gynecological surgery, resulting in chronic post-hysterectomy pain (CPHP), an important pain syndrome.We conducted a prospective cohort study in 216 Asian women who underwent abdominal or laparoscopic hysterectomy for benign conditions.

Demographic, psychological, and perioperative data were recorded.Postoperative 4- and 6-month phone surveys were conducted to assess the presence of CPHP and functional impairment.The incidence rates of CPHP at 4 and 6 months were 32% (56/175) and 15.

7% (25/159), respectively.Women with CPHP at 4 and 6 months had pain that interfered with their activities of daily living.Independent association factors for CPHP at 4 months were higher mechanical temporal summation score, higher intraoperative morphine consumption, higher pain score in the recovery room, higher pain score L-Ornithine during coughing and itching at 24 hours postoperatively, and preoperative pain in the lower abdominal region.

Independent association factors for CPHP at 6 months were preoperative pain during sexual intercourse, higher mechanical temporal summation score, and higher morphine consumption during postoperative 24 and 48 hours.In a majority of cases, CPHP resolved with time, but may have significant impact on activities of daily living.Keywords: chronic pain, hysterectomy, mechanical temporal summation score, postsurgical pain, central sensitization, morphine.