Podium Session

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PD50-12: High catastrophizing in patients with self-reported painful mesh complications have poorer outcomes

Monday, May 15
8:50 AM - 9:00 AM
Location: BCEC: Room 157

Presentation Authors: Juzar Jamnagerwalla*, Karyn S. Eilber, Jennifer T. Anger, A. Lenore Ackerman, Los Angeles, CA

Introduction: The pain catastrophization scale (PCS) was developed to help identify those patients likely to have an exaggerated negative mental thought process in response to pain. Catastrophizing has been shown to be a risk factor for chronicity of pain, disability, and depression. Patients who catastrophize after surgery have worse outcomes and longer duration of pain. Given this, we sought to identify the rate of catastrophizing in cohort of patients with mesh complications and chronic pain.

Methods: Patients throughout the US with self-described complications of vaginal mesh were recruited through advertisements to complete an internet-based anonymous survey. All patients filled out the PCS and the Genitourinary Pain Index (GUPI) questionnaire. The PCS is a 13-question survey with scores ranging from 0-52. Previous studies have established distribution of scores from subjects with chronic pain, with a score of 30 or higher representing the highest quartile, thus a score ≥30 was used to define high pain catastrophizing. Additional data was abstracted including age, number of previous pelvic surgeries, and intent to sue. Statistical analysis was performed using χ2 test and t-test for categorical and continuous variables, respectively.

Results: A total of 133 patients were included in the study, of which 78 patients (59%) were found to have high pain catastrophizing. There was no significant difference between baseline age, intent to sue, or number of previous pelvic surgeries between those who catastrophized and did not. Patients who catastrophized were significantly more likely to have a higher GUPI score (33.8 vs. 27.7, p<0.001) along with significant differences in pain (16.3 vs. 13.0, p<0.001) and quality of life (10.8 vs. 9.1, p<0.001) subdomains. Furthermore, patients who catastrophized tended to have less hope that they would recover (38.5% vs. 23.6%) which approached but did not reach statistical significance (p=0.072).

Conclusions: Patients with self-described mesh complications have a high rate of pain catastrophizing, which is associated with significantly worse quality of life and pain scores. Given that previous studies have also shown catastrophizing is associated with higher pain intensity, disability, and psychological distress (Weber et al, 2001), identifying high catastrophizing patients in the setting of chronic pelvic pain from mesh complications may help guide treatment and be an indicator for early or adjunctive psychosocial intervention.

Source Of Funding: none

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