Peripheral and Central Nervous System Correlates of Persistent Post-Hysterectomy Pain
Chronic Pelvic Pain (CPP) is a debilitating problem that afflicts 15-20% of women in the United States. Although over 200,000 hysterectomies are performed annually for the treatment of CPP, 1 in 4 women undergo the discomfort and morbidity of hysterectomy without relief of pain. Factors that predict treatment failure remain poorly characterized. While the pathogenesis of CPP is not fully understood, the best-supported hypothesis is that CPP is a heterogeneous condition that results from a complex interaction between pathology in peripheral tissues (e.g. endometriosis), the peripheral nervous system (PNS), and the central nervous system (CNS), each with variable contribution in any given patient with CPP. Preliminary data presented in this application confirms that a subset of women with CPP exhibit evidence of peripheral and central sensitization. The objective of this prospective observational cohort study is to characterize role of peripheral and central sensitization among women undergoing hysterectomy for CPP and to explore the utility of preoperative measures of PNS and CNS factors to predict the likelihood of acute and chronic post-hysterectomy pain and opioid use after hysterectomy.