Association of Central Sensitization Inventory Scores With Pain Outcomes After Endometriosis Surgery

Natasha L Orr, Alice J Huang, Yang Doris Liu, Heather Noga, Mohamed A Bedaiwy, Christina Williams, Catherine Allaire, Paul J Yong, Natasha L Orr, Alice J Huang, Yang Doris Liu, Heather Noga, Mohamed A Bedaiwy, Christina Williams, Catherine Allaire, Paul J Yong

Abstract

Importance: A subset of people who undergo surgery for endometriosis have persistent pain, suggesting that other factors besides the endometriosis, such as central sensitization, may play a role in this pain. The Central Sensitization Inventory, a validated self-reported questionnaire of central sensitization symptoms, may identify individuals with endometriosis who have more pain after surgery due to pain sensitization.

Objective: To examine whether greater baseline Central Sensitization Inventory scores are associated with postsurgical pain outcomes.

Design, setting, and participants: This prospective, longitudinal cohort study performed at a tertiary center for endometriosis and pelvic pain in British Columbia, Canada, included all patients aged 18 to 50 years with diagnosed or suspected endometriosis and a baseline visit between January 1, 2018, and December 31, 2019, who underwent surgery after the baseline visit. Individuals who were menopausal, had a prior hysterectomy, or were missing data for outcomes or measures were excluded. Data analysis was performed from July 2021 to June 2022.

Main outcomes and measures: The primary outcome was chronic pelvic pain at follow-up measured on a scale of 0 to 10, with 0 to 3 indicating no pain or mild pain, 4 to 6 indicating moderate pain, and 7 to 10 indicating severe pain. Secondary outcomes were deep dyspareunia, dysmenorrhea, dyschezia, and back pain at follow-up. The main variable of interest was baseline Central Sensitization Inventory score (measured from 0 to 100, consisting of 25 self-reported questions rated from 0 to 4 [never, rarely, sometimes, often, and always, respectively]).

Results: A total of 239 patients (mean [SD] age, 34 [7] years; 189 [79.1%] White [11 (5.8%) identified as White mixed with another ethnicity], 1 [0.4%] Black or African American, 29 [12.1%] Asian, 2 [0.8%] Native Hawaiian or Pacific Islander, 16 [6.7%] other, and 2 [0.8%] mixed race or ethnicity) with follow-up data at more than 4 months after surgery were included in this study (71.0% follow-up rate). The mean (SD) baseline Central Sensitization Inventory score was 43.8 (18.2), and the mean (SD) follow-up was 16.1 (6.1) months. Higher baseline Central Sensitization Inventory scores were significantly associated with higher chronic pelvic pain (odds ratio [OR], 1.02; 95% CI, 1.00-1.03; P = .02), deep dyspareunia (OR, 1.03; 95% CI, 1.01-1.04; P = .004), dyschezia (OR, 1.03; 95% CI, 1.01-1.04; P < .001), and back pain (OR, 1.02; 95% CI, 1.00-1.03; P = .02) at follow-up, when controlling for baseline pain scores. The Central Sensitization Inventory scores themselves decreased slightly from baseline to follow-up (mean [SD] score, 43.8 [18.2] vs 41.7 [18.9]; P = .05); however, individuals with high baseline Central Sensitization Inventory scores still had high scores at follow-up.

Conclusions and relevance: In this cohort study of 239 patients with endometriosis, higher Central Sensitization Inventory scores at baseline were associated with worse pain outcomes after endometriosis surgery, when controlling for baseline pain scores. The Central Sensitization Inventory could be used to counsel patients with endometriosis on their expected outcomes after surgery.

Conflict of interest statement

Conflict of Interest Disclosures: Dr Bedaiwy reported receiving personal fees from AbbVie Advisory Board, Ferring, and Baxter Advisory Board outside the submitted work. Dr Allaire reported receiving personal fees from AbbVie and Pfizer outside the submitted work. Dr Yong reported receiving financial support to travel, attend, and present at meetings from the Canadian Society for the Advancement of Gynecologic Excellence, the International Society for the Study of Women's Sexual Health, the International Pelvic Pain Society, and the World Endometriosis Society. No other disclosures were reported.

Figures

Figure 1.. Study Sample
Figure 1.. Study Sample
Inclusion and exclusion criteria to produce the final study sample. BSO indicates bilateral salpingo-oophorectomy; CPP, chronic pelvic pain; CSI, Central Sensitization Inventory.
Figure 2.. Mean Baseline Central Sensitization Inventory…
Figure 2.. Mean Baseline Central Sensitization Inventory (CSI) Scores at Baseline and Follow-up by Number of Central Sensitivity Syndromes (CSSs)
A greater number of CSSs and pelvic pain-related comorbidities was associated with high CSI scores at both baseline (r = .71, P < .001) and follow-up (r = .45, P < .001).

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