Should Gynecologists Test for Pain Sensitization?

One of the most common procedures undertaken in the field of gynecology is operative laparoscopy in the diagnosis and management of acute and chronic pelvic pain [1]. In the former situation, the diagnosis is usually apparent: hemorrhage emanating from an ectopic pregnancy or ruptured ovarian cyst, inflammation from pelvic infection or mechanical torsion of a visceral structure. In chronic states however, there is less specificity. Reports consistently demonstrate there is a “negative” rate of laparoscopy of 25-40% in cases of chronic pelvic pain [2,3]. This can be particularly upsetting if the woman is simply told that “nothing was found”. Even when there is evidence of a lesion in the pelvis, the effect of surgery may not have any bearing on the change in pain postoperatively as no clear associations are found between size of pathology and intensity of pain [4]. It is possible the cause of pain may be attributed to a visible lesion while in fact the cause of pain is due to a non-visible lesion. This is a perspective commonly seen in many other conditions e.g. revision surgery after otherwise technically successful total knee replacement, revision of prior back surgery, nerve damage, or gastric ulcers [5,6]. The specific objective of this presentation is to explore the possible reasons for these outcomes and propose options that may act to mitigate them. Pain SensitizationDetectable Pre-Operatively but Invisible at Laparoscopy