From the Guidelines
Pain Control Options for Ovarian Cysts
For the management of pain associated with ovarian cysts, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400-800mg every 6-8 hours) or naproxen (250-500mg every 8-12 hours) are recommended as first-line therapy 1. In cases of severe pain, acetaminophen (650-1000mg every 4-6 hours) may be added or used as an alternative.
Additional Considerations
- Hormonal therapies such as oral contraceptives (e.g., ethinyl estradiol 20-35mcg and levonorgestrel 0.1-0.15mg) may be considered to reduce cyst formation and alleviate symptoms.
- Multimodal analgesia, including nonsteroidal anti-inflammatory drugs and acetaminophen, can be effective in managing pain 1.
- Adjuvant analgesics, such as tricyclic antidepressants, may be used to enhance opioid effects 1.
- Patient-controlled analgesia may be considered for patients with severe pain, allowing for continuous or scheduled dosing rather than as-needed administration 1.
Key Principles
- Pain management is essential for maximizing patient outcomes, and mounting evidence shows that survival is linked to effective pain control 1.
- Comprehensive pain assessment must be performed, and pain intensity must be quantified and characterized by the patient whenever possible 1.
- Regularly scheduled analgesics with supplemental doses as needed can help manage breakthrough pain 1.
From the Research
Options for Pain Control in Patients with Ovarian Cysts
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are a first-line treatment option for pain relief from dysmenorrhea, which may also be effective for ovarian cysts 2
- Acetaminophen is another option for pain relief, especially for patients who cannot tolerate NSAIDs or have a history of gastrointestinal bleeding, cardiovascular disease, or chronic renal disease 3, 4
- Topical NSAIDs may be recommended for localized pain associated with ovarian cysts 3
- Hormonal contraceptives, such as combined oral contraceptives (COCs), may be considered for women who wish to use contraception and experience dysmenorrheic pain relief 2
- For severe or refractory pain, treatment can be briefly escalated with the use of medications that work on opioid and monoamine receptors, such as tramadol or tapentadol, or with the use of acetaminophen/opioid or NSAID/opioid combinations 3
- Other options, such as muscle relaxants, may be useful for specific conditions, such as acute low back pain associated with ovarian cysts 3
Considerations for Pain Management
- The choice of pain management should be tailored to each patient, including a review of treatment expectations and a plan for the time course of prescriptions 3
- Patients with a history of gastrointestinal bleeding, cardiovascular disease, or chronic renal disease should use NSAIDs with caution 3, 5
- Patients with advanced hepatic disease, malnutrition, or severe alcohol use disorder should use lower doses of acetaminophen 3
- The use of opioids should be minimized, and patients should be closely monitored for signs of opioid use disorder 3