Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada.
University of British Columbia Endometriosis and Pelvic Pain Laboratory, Vancouver, British Columbia, Canada.
JAMA Netw Open. 2023 Feb 1;6(2):e230780. doi: 10.1001/jamanetworkopen.2023.0780.
A subset of people who undergo surgery for endometriosis have persistent pain, suggesting that other factors besides the endometriosis, such as central sensitization, may play a role in this pain. The Central Sensitization Inventory, a validated self-reported questionnaire of central sensitization symptoms, may identify individuals with endometriosis who have more pain after surgery due to pain sensitization.
To examine whether greater baseline Central Sensitization Inventory scores are associated with postsurgical pain outcomes.
DESIGN, SETTING, AND PARTICIPANTS: This prospective, longitudinal cohort study performed at a tertiary center for endometriosis and pelvic pain in British Columbia, Canada, included all patients aged 18 to 50 years with diagnosed or suspected endometriosis and a baseline visit between January 1, 2018, and December 31, 2019, who underwent surgery after the baseline visit. Individuals who were menopausal, had a prior hysterectomy, or were missing data for outcomes or measures were excluded. Data analysis was performed from July 2021 to June 2022.
The primary outcome was chronic pelvic pain at follow-up measured on a scale of 0 to 10, with 0 to 3 indicating no pain or mild pain, 4 to 6 indicating moderate pain, and 7 to 10 indicating severe pain. Secondary outcomes were deep dyspareunia, dysmenorrhea, dyschezia, and back pain at follow-up. The main variable of interest was baseline Central Sensitization Inventory score (measured from 0 to 100, consisting of 25 self-reported questions rated from 0 to 4 [never, rarely, sometimes, often, and always, respectively]).
A total of 239 patients (mean [SD] age, 34 [7] years; 189 [79.1%] White [11 (5.8%) identified as White mixed with another ethnicity], 1 [0.4%] Black or African American, 29 [12.1%] Asian, 2 [0.8%] Native Hawaiian or Pacific Islander, 16 [6.7%] other, and 2 [0.8%] mixed race or ethnicity) with follow-up data at more than 4 months after surgery were included in this study (71.0% follow-up rate). The mean (SD) baseline Central Sensitization Inventory score was 43.8 (18.2), and the mean (SD) follow-up was 16.1 (6.1) months. Higher baseline Central Sensitization Inventory scores were significantly associated with higher chronic pelvic pain (odds ratio [OR], 1.02; 95% CI, 1.00-1.03; P = .02), deep dyspareunia (OR, 1.03; 95% CI, 1.01-1.04; P = .004), dyschezia (OR, 1.03; 95% CI, 1.01-1.04; P < .001), and back pain (OR, 1.02; 95% CI, 1.00-1.03; P = .02) at follow-up, when controlling for baseline pain scores. The Central Sensitization Inventory scores themselves decreased slightly from baseline to follow-up (mean [SD] score, 43.8 [18.2] vs 41.7 [18.9]; P = .05); however, individuals with high baseline Central Sensitization Inventory scores still had high scores at follow-up.
In this cohort study of 239 patients with endometriosis, higher Central Sensitization Inventory scores at baseline were associated with worse pain outcomes after endometriosis surgery, when controlling for baseline pain scores. The Central Sensitization Inventory could be used to counsel patients with endometriosis on their expected outcomes after surgery.
接受子宫内膜异位症手术的一部分人仍有持续性疼痛，这表明除了子宫内膜异位症之外，其他因素（如中枢敏化）可能在这种疼痛中起作用。中枢敏化量表是一种经过验证的中枢敏化症状的自我报告问卷，它可以识别出在手术后由于疼痛敏化而出现更多疼痛的子宫内膜异位症患者。
研究基线中枢敏化量表评分是否与手术后疼痛结果相关。
设计、地点和参与者：这是一项在加拿大不列颠哥伦比亚省的子宫内膜异位症和盆腔疼痛的三级中心进行的前瞻性、纵向队列研究，包括所有年龄在 18 至 50 岁之间、被诊断或疑似患有子宫内膜异位症并在 2018 年 1 月 1 日至 2019 年 12 月 31 日之间进行基线就诊的患者，且在基线就诊后接受了手术。排除绝经、已行子宫切除术或缺失结局或测量数据的个体。数据分析于 2021 年 7 月至 2022 年 6 月进行。
主要结局是在随访时用 0 到 10 的量表衡量的慢性盆腔疼痛，0 到 3 表示无疼痛或轻度疼痛，4 到 6 表示中度疼痛，7 到 10 表示重度疼痛。次要结局是深部性交痛、痛经、排便困难和背痛。主要关注的变量是基线中枢敏化量表评分（范围从 0 到 100，由 25 个自我报告的问题组成，评分范围从 0 到 4[分别为从不、很少、有时、经常和总是]）。
共有 239 名患者（平均[标准差]年龄为 34[7]岁；189[79.1%]为白人[11 人[5.8%]为白人混合其他种族]，1[0.4%]为黑人或非裔美国人，29[12.1%]为亚洲人，2[0.8%]为夏威夷原住民或太平洋岛民，16[6.7%]为其他，2[0.8%]为混合种族或族裔）接受了随访超过 4 个月的手术（71.0%的随访率）。基线中枢敏化量表的平均（标准差）评分是 43.8（18.2），平均（标准差）随访时间是 16.1（6.1）个月。较高的基线中枢敏化量表评分与更高的慢性盆腔疼痛（优势比[OR]，1.02；95%置信区间[CI]，1.00-1.03；P = .02）、深部性交痛（OR，1.03；95%CI，1.01-1.04；P = .004）、排便困难（OR，1.03；95%CI，1.01-1.04；P < .001）和背痛（OR，1.02；95%CI，1.00-1.03；P = .02）显著相关，当控制基线疼痛评分时。中枢敏化量表本身在基线到随访期间略有下降（平均[标准差]评分，43.8[18.2]vs 41.7[18.9]；P = .05）；然而，高基线中枢敏化量表评分的个体在随访时仍有较高的评分。
在这项对 239 名子宫内膜异位症患者的队列研究中，基线中枢敏化量表评分较高与子宫内膜异位症手术后疼痛结局较差相关，当控制基线疼痛评分时。中枢敏化量表可用于向子宫内膜异位症患者提供手术后的预期结果。
