Opioid Prescription Usage after Benign Gynecologic Surgery: A Prospective Cohort Study

Study Objective To compare the amount of opioids (tablets and morphine milligram equivalents [MMEs]) prescribed by physicians and used by patients after benign gynecologic surgery. Design Prospective cohort study. Setting Tertiary center: main hospital operating room and outpatient surgery center. Patients Women undergoing benign gynecologic surgery. Interventions Major and minor gynecologic surgeries. Measurements and Main Results The surgery groups were minor laparoscopy (Minor), major minimally invasive (Major), and laparotomy (Laparotomy). Demographic, medical, and surgical data were abstracted from electronic medical records. On postoperative day (POD) 7, women completed a telephone survey describing pain levels, prescription use, and satisfaction with pain control. Patients who continued to use opioids for pain relief were surveyed on POD 14. If use continued, patients were surveyed again on POD 28. The primary outcome was amount of opioid prescribed compared with opioid used. Of 193 screened participants 172 were enrolled (89%), and data were analyzed for 154 (90%): 59 (38%) Major, 71 (56%) Minor, and 24 (16%) Laparotomy. The median number of tablets and MMEs prescribed was lowest for the Minor group (Minor, 24 tablets; Major, 30 tablets; Laparotomy, 30 tablets [p <.01]; Minor, 150 MMEs; Major, 225 MMEs; Laparotomy, 225 MMEs [p = .01]). We found no difference in the number of tablets (Minor, 8; Major, 8; Laparotomy, 9; p = .77) or MMEs used (Minor, 45 MMEs; Major, 45 MMEs; Laparotomy, 55 MME; p = .81) between the groups. On POD 7 there was no difference in median numerical rating scale pain scores (Minor, 3; Major, 2; Laparotomy, 2; p = .07) or satisfaction with analgesia on POD 7 (p = .44), 14 (p = .87), and 28 (p = .18). Patients with prior chronic pain used more total amounts of opioids (68 MME vs 30 MME, p <.01) and were more likely to require opioid refill (odds ratio, 10.4; 95% confidence interval, 1.3–83.6) compared with those without a similar history. Conclusion In this cohort, gynecologic surgeons prescribed nearly 3 times more opioid tablets and MMEs than was used by patients despite patients reporting similar levels of pain after minor and major surgeries

Vulvodynia is not created equally: empirical classification of women with vulvodynia

Background: Vulvodynia classification is based on the sensory dimensions of pain and does not include psychological factors associated with the pain experience and treatment outcomes. Previous work has shown that individuals with chronic pain can be classified into subgroups based on pain sensitivity, psychological distress, mood, and symptom severity. Objective: The aim of this study was to identify distinct subgroups of women with vulvodynia enrolled in the National Vulvodynia Registry. We hypothesized that women with vulvodynia can be clustered into subgroups based on distress and pain sensitivity. Design: A cross-sectional study. Methods: We conducted an exploratory hierarchical agglomerative cluster analysis using Ward’s cluster method and squared Euclidean distances to identify unique subgroups based on baseline psychological distress and pain sensitivity. The variables included the catastrophizing subscale of the Coping Strategies Questionnaire, the Beck Depression Inventory, the State Trait Anxiety Index-Trait scale, McGill Pain Questionnaire-Affective subscale, and vulvar and pelvic muscle pressure pain sensitivity. Subjects: Eight sites enrolled women who presented with vaginal or vulval pain of at least 3-month duration. Results: Two distinct subgroups, high pain sensitivity with high distress (n=27) and low pain sensitivity with low distress (n=100), emerged from the cluster analysis. Validation indicated that subgroups differed in terms of clinical pain intensity, sensory aspects of pain, and intercourse pain. Conclusion: Empirical classification indicates that unique subgroups exist in women with vulvodynia. Providers should be aware of the heterogeneity of this condition with respect to pain-related distress and pain sensitivity

Novel Medical Therapy for Refractory Endometriosis Associated Chronic Pelvic Pain: an Open Label Trial of Thalidomide

Background: Endometriosis affects 2.5-3.3% of reproductive age women and is a common diagnosis among women with chronic pelvic pain. Treatment for endometriosis ranges from conservative medical therapies to radical surgery. Endometriosis is an indication for 25-35% of laparoscopies and 10-15% of hysterectomies each year . Although the majority of women with endometriosis respond to conservative medical therapy, those with persistent pain often undergo hysterectomy. Based on clinical and experimental data that indicate that thalidomide may be a highly effective immune modulator, we sought to investigate the efficacy and tolerability of this novel therapy for endometriosis associated pain patients who desired fertility-sparing treatment after exhausting all other conservative modalities. Objective: To investigate the efficacy and tolerability of thalidomide as a treatment for endometriosis associated pain patient

Overlap Between Orofacial Pain and Vulvar Vestibulitis Syndrome

To explore the prevalence of Orofacial Pain (OFP) among patients with Vulvar Vestibulitis Syndrome (VVS) and to examine the relationship between signs and symptoms of OFP and clinical characteristics of women with VVS; we specifically sought to investigate differences in psychological characteristics and self-reported severity of painful intercourse

Knowledge and Beliefs about Mechanism of Action of Birth Control Methods among European Women

Background: Adequate knowledge is essential for making informed decisions. We attempted to determine the level of knowledge about mechanisms of action of birth control methods in five representative samples of European women. Study design: Randomly selected women, aged 18-49 years, completed an anonymous survey in Germany, France, the UK, Sweden and Romania (N=1137). Participants were asked about how contraceptive methods work and if providers should inform them about this issue. Multiple linear regression was used to evaluate women’s characteristics associated with their knowledge of mechanisms of action. Results: The majority of women identified the unequivocal mode of action of condoms, sterilization and abortion. Less than 2% identified all possible mechanisms of action of hormonal contraceptives and intrauterine devices. Highly-educated women correctly identified the mechanism or mechanisms of action of more methods than less educated women (β coef.=0.22, 95%CI=0.01-0.43). Regardless of their sociodemographic characteristics and their belief about when human life begins, most women (75%) stated that the provider should inform them about possible postfertilization effects. Conclusions: European women have low knowledge about mechanisms of action of several contraceptive methods. The majority want to be informed about possible postfertilization effects. Since adequate knowledge is essential for making informed decisions, providers are encouraged to inform women about all possible mechanisms of action of contraceptives

Musculoskeletal Considerations In Female Patients With Chronic Pelvic Pain

Persistent pelvic pain conditions are common and affect nearly 25% of the female U.S. population. In a sizable proportion of pelvic pain patients, the pain is caused by musculoskeletal dysfunction; yet, healthcare providers do not routinely evaluate patients for musculoskeletal etiologies. This article provides an overview of the pathophysiology of persistent pelvic pain, as it relates to musculoskeletal disorders. The symptomatology, anatomy, evaluation, and treatment of these disorders are summarized specifically for healthcare providers (including gynecologists) who do not have pelvic musculoskeletal expertise

Vulvodynia Is Not Created Equally: Empirical Classification Of Women With Vulvodynia

Background: Vulvodynia classification is based on the sensory dimensions of pain and does not include psychological factors associated with the pain experience and treatment outcomes. Previous work has shown that individuals with chronic pain can be classified into subgroups based on pain sensitivity, psychological distress, mood, and symptom severity. Objective: The aim of this study was to identify distinct subgroups of women with vulvodynia enrolled in the National Vulvodynia Registry. We hypothesized that women with vulvodynia can be clustered into subgroups based on distress and pain sensitivity. Design: A cross-sectional study. Methods: We conducted an exploratory hierarchical agglomerative cluster analysis using Ward’s cluster method and squared Euclidean distances to identify unique subgroups based on baseline psychological distress and pain sensitivity. The variables included the catastrophizing subscale of the Coping Strategies Questionnaire, the Beck Depression Inventory, the State Trait Anxiety Index-Trait scale, McGill Pain Questionnaire-Affective subscale, and vulvar and pelvic muscle pressure pain sensitivity. Subjects: Eight sites enrolled women who presented with vaginal or vulval pain of at least 3-month duration. Results: Two distinct subgroups, high pain sensitivity with high distress (n=27) and low pain sensitivity with low distress (n=100), emerged from the cluster analysis. Validation indicated that subgroups differed in terms of clinical pain intensity, sensory aspects of pain, and intercourse pain. Conclusion: Empirical classification indicates that unique subgroups exist in women with vulvodynia. Providers should be aware of the heterogeneity of this condition with respect to pain-related distress and pain sensitivity