Hysterectomy for Chronic Pelvic Pain

For well selected patients with chronic pelvic pain (CPP), 74% to 95% of women will report complete or significant improvement in pain after hysterectomy. A thoughtful history, examination, and review of imaging can improve success by linking pain complaints to discrete pathology, menstrual activity, or uterine tenderness. All patients with CPP should be evaluated for chronic overlapping pain conditions (COPCs) (eg, irritable bowel syndrome (IBS), fibromyalgia) and risk factors for persistent pain or chronic postsurgical pain (eg, depression, pain catastrophizing, central sensitization), and offered treatment as indicated. There are special considerations for preoperative planning and enhanced recovery for patients with chronic pain.