ABSTRACT

Background. Chronic postoperative pelvic pain (CPP) is a pain syndrome that persists for more than three months following surgical interventions and significantly impairs patients' quality of life. The prevalence of CPP ranges from 2% to 30%, and the lack of standardized treatment protocols underscores the relevance of implementing a multimodal and individualized approach to managing this condition.

Purpose. To evaluate the effectiveness of comprehensive therapy for chronic postoperative pelvic pain, taking into account the type of prior surgical intervention and the predominant pathophysiological mechanism of the pain syndrome.

Materials and methods. A retrospective analysis was conducted involving 14 patients with a confirmed diagnosis of chronic postoperative pelvic pain. Diagnostic evaluation included assessment of pain intensity using the Visual Analog Scale (VAS), palpation of pelvic muscles, and testing for the presence of a neuropathic pain component. Treatment effectiveness was assessed using the VAS and the Global Response Assessment (GRA) scale. A correlation analysis was performed to identify associations between patients’ medical histories, treatment modalities used, and therapeutic outcomes.

Results. Prior to treatment, the mean VAS score was 4.8±1.31. Clinical improvement was observed in 85.7% of patients, with a mean GRA score of 5.7±1.07. A negative correlation was found between previous mesh hernioplasty and clinical improvement, indicating a higher risk of implant-associated pain syndrome. Similarly, gabapentin monotherapy showed a negative correlation with treatment success, suggesting the involvement of additional pain mechanisms beyond neuropathic origin. Standard analgesics were found to be ineffective. The most favorable therapeutic outcomes were achieved with a combination of peripheral nerve blocks and physiotherapy. Myofascial pain was successfully managed with obturator internus muscle blocks in conjunction with muscle relaxants. In cases of neuropathic pain, combined administration of gabapentin and tricyclic antidepressants demonstrated high efficacy.

Conclusion. The study results confirmed the high efficacy of a combined therapeutic approach in the treatment of chronic postoperative pelvic pain. The greatest clinical improvement was observed with the use of peripheral nerve blocks in combination with physiotherapeutic modalities. The use of synthetic implants was associated with an increased risk of persistent implant-related pain syndrome. The lack of effect from standard analgesics highlights the need for detailed diagnostics to identify neuropathic and myofascial pain components. Therefore, the treatment of CPP requires a personalized and multidisciplinary strategy, with careful consideration of the underlying pathophysiological mechanism and clinic.

ABOUT AUTHORS

LITERATURE

1. Butrick C. W. Persistent Postoperative Pain: Pathophysiology, Risk Factors, and Prevention / C. W. Butrick // Female Pelvic Medicine and Reconstructive Surgery. — 2016. — Vol. 22, № 5. — P. 390–396.
2. Clark J. D. Chronic Postoperative Pain: Preventable or Inevitable? / J. D. Clark // Anesthesiology. — 2021. — Vol. 135, № 2. — P. 215–217.
3. Ji R. R. Neuroinflammation and central sensitization in chronic and widespread pain / R. R. Ji [et al.] // Anesthesiology. — 2018. — Vol. 129, № 2. — P. 343–366.
4. Özgür E. Chronische schmerzen in der urologie: Leistenschmerzen, postvasektomie-schmerzen und chronische beckenschmerzen / E. Özgür, O. Dagtekin // Wiener Medizinische Wochenschrift. — 2009. — Vol. 159, № 21–22. — P. 543–547.
5. van Rijckevorsel D. C. M. Risk factors for chronic postsurgical abdominal and pelvic pain / D. C. M. van Rijckevorsel [et al.] // Pain management. — 2015. — Vol. 5, № 2. — P. 107–116.
6. Bendavid R. A mechanism of mesh-related post-herniorrhaphy neuralgia / R. Bendavid [et al.] // Hernia. — 2016. — Vol. 20, № 3. — P. 357–365.
7. Lai C. Z. Scrotal Pain after Varicocelectomy: A Narrative Review / C. Z. Lai [et al.] // Biomedicines. — 2023. — Vol. 11, № 4.
8. Waller T. J. Wallerian Degeneration and Clearance of Olfactory Receptor Neuron Axons following Drosophila Antennal Transection / T. J. Waller, L. J. Smithson, C. A. Collins // Cold Spring Harb Protoc. — 2024.
9. MacCraith E. Comparison of synthetic mesh erosion and chronic pain rates after surgery for pelvic organ prolapse and stress urinary incontinence: a systematic review / E. MacCraith [et al.] // International Urogynecology Journal. — 2021. — Vol. 32, № 3. — P. 573–580.
10. Maher C. Transvaginal mesh or grafts compared with native tissue repair for vaginal prolapse / C. Maher [et al.] // Cochrane Database of Systematic Reviews. — 2016. — Vol. 2016, № 2.
11. Lee D. Iatrogenic Pelvic Pain: Surgical and Mesh Complications / D. Lee, J. Chang, P. E. Zimmern // Physical Medicine and Rehabilitation Clinics of North America. — 2017. — Vol. 28, № 3. — P. 603–619.