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A Prospective Study of Risk Factors for Pain Persisting 4 Months After Hysterectomy

Brandsborg, Birgitte MD*; Dueholm, Margit PhD; Nikolajsen, Lone PhD* ‡; Kehlet, Henrik MD, PhD§; Jensen, Troels S. PhD*

Clinical Journal of Pain:
doi: 10.1097/AJP.0b013e31819655ca
Original Articles
Abstract

Objectives: Chronic pain after hysterectomy is reported by 5% to 32% of women, but it is unknown whether the pain is a result of surgery or can be attributable to other factors such as preoperative and postoperative pain, physical, and psychosocial status. The aim of this prospective study was therefore to study the role of surgery and other possible predictors for pain 4 months after hysterectomy.

Methods: Ninety women referred for hysterectomy for benign conditions completed the study. The women were interviewed and completed pain questionnaires before surgery and after 3 weeks and 4 months. Questions were about pain location, intensity, and frequency, as well as medical treatment and impact on daily living. In addition, the Short Form-36 General Health Status Questionnaire and Coping Strategies Questionnaire were completed before surgery.

Results: Fifteen women (16.7%) had persistent pain 4 months after hysterectomy. In 11 women, the pain resembled their preoperative pain, whereas 4 women had pain likely to be related to surgery. Preoperative “pain problems elsewhere” and a high “acute postoperative pain intensity” were associated with having pain 4 months after hysterectomy (P=0.004 and P=0.034). A similar tendency was seen for preoperative “pelvic pain” (P=0.059). Women with pain at 4 months reported lower quality of life in 4 Short Form-36 subscales and less control of pain preoperatively (P<0.05 and P=0.023).

Discussion: Pain persisting 4 months after hysterectomy is most often related to preoperative factors and acute postoperative pain. The relative contribution of surgery itself is small.

Author Information

*Danish Pain Research Center

Departments of Obstetrics and Gynecology

Anesthesiology, Aarhus University Hospital, Aarhus

§Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen, Denmark

Supported by a grant from the Lundbeck Foundation, Hellerup, Denmark and the Faculty of Health Sciences, Institute of Clinical Medicine, University of Aarhus, Aarhus, Denmark. Disclosure of Interests: None of the authors have any financial, personal, or other conflicts of interests.

Reprints: Birgitte Brandsborg, MD, Danish Pain Research Center, Aarhus University Hospital, Noerrebrogade 44, Bldg. 1A, 8000 Aarhus C, Denmark (e-mail: birgitte.brandsborg@ki.au.dk).

Received for publication September 23, 2008; revised October 26, 2008; accepted November 1, 2008

© 2009 Lippincott Williams & Wilkins, Inc.