A prospective study of risk factors for pain persisting 4 months after hysterectomy.

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.