Investigation into Levels of Pain, Quality of Life, and Depression by Stage of Endometriosis Public Deposited

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  • February 22, 2019
  • Vinikoor, Lisa C.
    • Other Affiliation: U.S. Environmental Protection Agency, Research Triangle Park, NC
  • Martin, Caitlin
    • Other Affiliation: Johns Hopkins School of Medicine, Baltimore, MD
  • Zolnoun, Denniz
    • Affiliation: School of Medicine, Department of Obstetrics and Gynecology
  • Objective: Despite the high prevalence of endometriosis, controversy exists surrounding the association between the stage of endometriosis and long-term treatment outcomes. The objective of the present study was to investigate the postsurgical long-term pain, quality-of-life, and psychological distress among women with differing stages of endometriosis. Methods: This cross-sectional study was conducted between 2008 and 2009. Women who had undergone surgery for pelvic pain at UNC Hospitals from 2003 to 2006 were mailed questionnaires to collect information on demographics, pain, sexual dysfunction, quality of life, and depression. Descriptive statistics and ANOVAs were used to examine the distribution of these variables by stage of endometriosis. Results: The study population included women aged 22 to 50 years old (mean age 36 years). Of the 82 women, 38 (46%) were classified as having stage 1 endometriosis, 26 (32%) having stage 2 endometriosis, 13 (16%) having stage 3 endometriosis, and 5 (6%) having stage 4 endometriosis. Across the four stages, there was no pattern of increased overall pain, pelvic pain, quality-of-life, or depression with increasing stage of endometriosis. The mean scores (standard deviation) on an adapted version of the McGill Pain Questionnaire for total pain were 8.0 (7.8), 10.4 (10.8), 4.6 (7.5), and 9.4 (13.4) for stages 1, 2, 3, and 4, respectively (ANOVA p-value 0.34). The mean scores for intensity of pelvic pain (possible score range of 0-5) were 1.5 (1.4), 1.7 (1.4), 1.0 (1.6), and 1.6 (0.9), respectively (ANOVA p-value 0.56). Using the SF12 quality-of-life measure the mean (standard deviation) mental and physical component standardized scores were 43.2 (10.3) and 45.6 (11.7) for stage 1, 45.5 (11.4) and 44.1 (10.2) for stage 2, 47.3 (12.8) and 50.4 (9.4) for stage 3, and 36.0 (14.8) and 43.3 (8.7) for stage 4 (ANOVA p-values 0.30 and 0.39 for the mental and physical components, respectively). Finally, scores on the Beck Depression Inventory were also similar by stage, although women with stage 4 endometriosis did score higher than the other three stages [stage 1: 9.2 (7.9), stage 2: 10.9 (7.5), stage 3: 8.3 (8.4) and stage 4: 16.2 (12.3)] (ANOVA p-value 0.26). Conclusions: These results indicate that long-term treatment outcomes in women undergoing laparoscopic surgery for pelvic pain may not be related to the stage of endometriosis. Regardless of endometriosis stage, most women were found to have residual pain symptoms. Further research to understand chronic pain, quality-of-life, and psychological distress and endometriosis is warranted. Summary: This study has shown that among women who underwent surgery for pelvic pain at UNC Hospitals, level of pain, quality-of-life, and depression do not increase with increasing stage of endometriosis.
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