Chronic Pelvic Pain, Health-related Quality of Life and Laparoscopic Adhesiolysis

Abstract

Objective: The purposes of this study were to assess the impact of chronic pelvic pain on quality of life, and to test the hypothesis of whether laparoscopic adhesiolysis leads to significant pain relief and improvement in quality of life (QoL) in patients with chronic pelvic pain (CPP). Methods: This was an intervention study, parallel design inter-subject and intra-subject variabilities, conducted in the hospital of Obstetrics and Gynecology, Damascus University over 2 years. The participants in this study were 70 women with chronic pelvic pain (CPP) who underwent laparoscopic adhesiolysis. The women were assessed at 0, 3, and 6 months by Numerical Rating Scale (NRS), Quality of life (QoL) measure (SF-36), and the Hospital Anxiety and Depression Scale (HADS). All these test scores were correlated together using paired t test. Results: Out of total 70 women who underwent laparoscopy, 62 were qualified to take part in this study. The results are expressed in mean. There was a significant correlation between the baseline average pain score, the baseline score of QoL measure, and the baseline score of HADS. NRS scores decrease from (5.53) prior to surgery to (3.46) and (3.94) at 3 and 6 months of follow-up. SF-36 survey analysis revealed that the greatest increases linked to physical domains, that is, bodily pain, from (55.56) to (71.28) and (70.31) at 3 and 6 months of follow-up, and RP which increased from (66.06) to (78.01) and (76.20) at 3 and 6 months of follow-up. Among the mental domains the most favorable results involved vitality (V), which increased from (46.58) to (57.93) and (58.66) at 3 and 6 months of follow-up, and RE which increased from (60.92) to (71.68) and (72.24) at 3 and 6 months, respectively. There was a significant improvement in HADS scores, the HADS-D decreased from (10.107) to (8.393) and (7.847) at 3 and 6 months of follow-up, and the HADS-A decreased from (9.607) to (8.607) and (8.849) at 3 and 6 months of follow-up. In 6 months, changes in all tests are correlated significantly with the change in average pain. Conclusions: A selected population of women having adhesions, presenting to gynecological clinic, are suffering from chronic pelvic pain. Laparoscopic adhesiolysis improves this pelvic pain, their quality of life, anxiety and depression in non-psychiatric, chronic pelvic pain populations.