Catastrophizing: a predictor of persistent pain among women with endometriosis at 1 year.

BACKGROUND: Endometriosis is the most common gynecological diagnosis among women with chronic pelvic pain, but the underlying mechanisms of endometriosis-associated chronic pelvic pain remain unclear. Therefore, the objective of this study was to determine the biopsychosocial predictors of pain improvement among women with endometriosis. METHODS: One hundred and fifteen women who presented for treatment of endometriosis-associated chronic pelvic pain at a tertiary referral center at a university-based hospital participated in this prospective observational study of clinical practice. Participants completed questionnaires assessing pain, mental health and catastrophizing at entry and 1 year follow-up. The main outcome measure assessed was the interval change in pain report using the McGill pain 1uestionnaire. RESULT(S): On average, participants experienced a 37.4% reduction in interval pain (P < 0.001). Adjusted for baseline pain, nulliparity (P = 0.002) and catastrophizing (P = 0.04) were associated with decreased probability of interval improvement in pain. Those referred for physical therapy had less interval pain improvement (P = 0.04). However, undergoing hysterectomy was a strong predictor of improvement in pain (P = 0.008). CONCLUSION(S): Our study suggests that chronic pain in endometriosis may be more akin to other idiopathic pain disorders. Specifically, biopsychosocial variables, such as catastrophizing, play an important role in reported severity. Further research on biopsychosocial correlates of chronic pelvic pain in endometriosis is warranted.

Use of anti-skid material and patient-positioning to prevent patient shifting during robotic-assisted gynecologic procedures.

STUDY OBJECTIVE: To estimate patient shifting with the current practice of use of an antiskid material and patient positioning during robotic procedures in gynecology. DESIGN: Pilot observational study (Canadian Task Force classification). SETTING: Tertiary referral center. PATIENTS: Twenty-two women undergoing robotic-assisted gynecologic procedures. INTERVENTION: Antiskid material (egg-crate pink foam) was placed beneath patients and patient positioning was used during robotic-assisted procedures. MEASUREMENTS AND MAIN RESULTS: Patient position was marked before and after surgery. Measurements of shift distance before and after surgery were determined for each patient. Median (range) shift distance was 1.3 (0-7.5) cm. There was no significant association between shift in position and either body mass index or duration of the Trendelenburg position. No shoulder neuropathic injuries were observed during the study. CONCLUSION: Minimal patient shifting is observed with the use of an antiskid material and patient positioning described, without the use of shoulder braces and straps.