Is there a correlation between hysterectomy and chronic pain in women?

From the Guidelines

Yes, there is a relationship between hysterectomy and chronic pain in women, with approximately 5-32% of women experiencing chronic pelvic pain following the procedure. Hysterectomy, the surgical removal of the uterus, can lead to chronic pain in some women, with this post-hysterectomy pain manifesting as pelvic pain, back pain, or pain during sexual intercourse. Several factors can contribute to this chronic pain, including the formation of adhesions (scar tissue), damage to surrounding nerves during surgery, changes in pelvic floor muscle function, or pre-existing pain conditions that persist after surgery. The surgical approach used (abdominal, vaginal, or laparoscopic) may influence pain outcomes, with minimally invasive techniques generally associated with less post-operative pain, as suggested by studies such as 1. Women with a history of chronic pain conditions, endometriosis, or pelvic inflammatory disease before surgery may be at higher risk for developing chronic pain after hysterectomy.

For women experiencing post-hysterectomy chronic pain, treatment options include pain medications, physical therapy focusing on pelvic floor rehabilitation, nerve blocks, psychological approaches like cognitive behavioral therapy, and in some cases, additional surgical intervention to address adhesions or nerve entrapment. It's worth noting that while studies like 1 discuss the outcomes of hysterectomy, more recent research such as 1 highlights the importance of considering long-term consequences of surgical procedures, including chronic pain. However, the most recent and highest quality study, 1, provides insights into the burden of chronic pain following surgical procedures, emphasizing the need for comprehensive management strategies.

Key factors to consider in managing post-hysterectomy chronic pain include:

• The use of preemptive analgesia to reduce postoperative pain, as recommended by 1
• The selection of the most appropriate surgical approach to minimize the risk of chronic pain
• The implementation of multidisciplinary treatment plans that address the physical and psychological aspects of chronic pain
• The consideration of individual risk factors that may predispose women to chronic pain after hysterectomy, such as pre-existing pain conditions or a history of endometriosis. The most effective approach to managing post-hysterectomy chronic pain will depend on a thorough assessment of each woman's unique circumstances and medical history.

From the Research

Relationship Between Hysterectomy and Chronic Pain in Women

• Chronic pelvic pain affects nearly 15% of women annually in the United States, with significant comorbidity and annual costs to the healthcare system estimated at approximately $2 billion per year 2.
• Hysterectomy is an accepted treatment for chronic pelvic pain, but it has important limitations, including the possibility of continued pain after surgery, with 21-40% of women experiencing pain after hysterectomy and 5% experiencing new onset of pain 2.
• Risk factors for chronic pain after hysterectomy include preoperative pelvic pain, pain elsewhere, acute postoperative pain, surgical procedure, and psychological factors such as anxiety and depression 3, 4.

Incidence of Chronic Pain After Hysterectomy

• Chronic pain following hysterectomy is reported in 10-50% of women, with neuropathic pain occurring in 5-50% of cases 3.
• A nationwide questionnaire and database study found that 31.9% of women reported pain 1 year after hysterectomy, with 13.7% experiencing pain more than 2 days a week 4.
• A prospective, observational cohort study found that 11.9% of women reported persistent pelvic pain 6 months after hysterectomy, with higher preoperative centralized pain scores associated with a greater risk of persistent pelvic pain 5.

Predictors of Persistent Pelvic Pain After Hysterectomy

• Preoperative centralized pain scores, but not depression or anxiety, were found to be a robust predictor of persistent pelvic pain after hysterectomy 5.
• Intraoperative findings of endometriosis and uterine fibroids were associated with a higher incidence of persistent pain, but the surgical route, pelvic adhesions, uterine weight, and adenomyosis on histopathology were not related to the risk of persistent pain 5.
• Neuropathic symptoms, such as hypoesthesia and hyperesthesia, were detected in 19.4% of patients around the abdominal scar after hysterectomy 6.