Korean J Obstet Gynecol.  2011 Sep;54(9):557-560. 10.5468/KJOG.2011.54.9.557.

Chronic pelvic pain after hysterectomy in a patient with depressive disorder: A case report

• Ha JE
• Son HJ
• Kim BY
• Jung YJ
• Chun GY
• Kim JH
• Kim MR
• Cho HH

• KMID: 2274084
• DOI: http://doi.org/10.5468/KJOG.2011.54.9.557

Abstract

Chronic pelvic pain, defined as a non-cyclic pain of at least 6 months duration, is severe enough to require medical care or to cause disability. For such reason, only physical approaches and managements of chronic pelvic pain sometimes fail. Depression and posttraumatic stress disorder (PTSD) can cause chronic pelvic pain and affects the course of pain management. This case is about chronic pelvic pain of 39-years-old unmarried woman with adenomyosis. She wanted to control her pelvic pain with medical treatments of adenomyosis, but finally decided to scarify uterus due to uncontrolled pain. Pshychosomatic symptoms were considered to cause the pain because her pain did not disappear even after hysterectomy. She was diagnosed with PTSD and depression. This case suggests that chronic pelvic pain patients always need psychological evaluation even if they have definite causes of pelvic pain in gynecological area.

Keyword

Pelvic pain; Depression; Stress disorders, post-traumatic; Psychosomatic symptom

MeSH Terms

Adenomyosis
Depression
Female
Humans
Hysterectomy
Pain Management
Pelvic Pain
Single Person
Stress Disorders, Post-Traumatic
Uterus

Figure

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  Fig. 1 Magnetic resonance imaging findings of the pelvic organ. Diffuse enlarged uterus showed highly heterogeneous signal intensity on T2WI. High signal intensity of endometrial cavity showed obliterated junctional zone. Uterus showed high signal intensity on T1WI. In contrast imaging, lace like enhancement of endometrial cavity and heterogenous enhancement of uterine wall was noted. R/O uterine sarcoma such as endometrial stromal sarcoma. R/O, rule out.

Reference

1. Zondervan KT, Yudkin PL, Vessey MP, Dawes MG, Barlow DH, Kennedy SH. The prevalence of chronic pelvic pain in women in the United Kingdom: a systematic review. Br J Obstet Gynaecol. 1998. 105:93–99.

2. Rush AJ, Polatin P, Gatchel RJ. Depression and chronic low back pain: establishing priorities in treatment. Spine (Phila Pa 1976). 2000. 25:2566–2571.

3. Stoudemire A, Kahn M, Brown JT, Linfors E, Houpt JL. Masked depression in a combined medical-psychiatric unit. Psychosomatics. 1985. 26:221–224. 227–228.

4. Krishnan KR, France RD, Pelton S, McCann UD, Davidson J, Urban BJ. Chronic pain and depression. I. Classification of depression in chronic low back pain patients. Pain. 1985. 22:279–287.

5. Peteet J, Tay V, Cohen G, MacIntyre J. Pain characteristics and treatment in an outpatient cancer population. Cancer. 1986. 57:1259–1265.

6. Koenig TW, Clark MR. Advances in comprehensive pain management. Psychiatr Clin North Am. 1996. 19:589–611.

7. Shin YK, Lee CU. Depressive disorder in patients with chronic pains. J Korean Pain Soc. 2002. 15:110–115.

8. Meltzer-Brody S, Leserman J, Zolnoun D, Steege J, Green E, Teich A. Trauma and posttraumatic stress disorder in women with chronic pelvic pain. Obstet Gynecol. 2007. 109:902–908.

9. Elliott DM, Mok DS, Briere J. Adult sexual assault: prevalence, symptomatology, and sex differences in the general population. J Trauma Stress. 2004. 17:203–211.

10. McLean SA, Clauw DJ, Abelson JL, Liberzon I. The development of persistent pain and psychological morbidity after motor vehicle collision: integrating the potential role of stress response systems into a biopsychosocial model. Psychosom Med. 2005. 67:783–790.

11. Katon W, Sullivan M, Walker E. Medical symptoms without identified pathology: relationship to psychiatric disorders, childhood and adult trauma, and personality traits. Ann Intern Med. 2001. 134:917–925.

12. Seok H, Son BK, Ha YR, Ryu HH, Moon JH. Clinical influence of emotional depression on chronic low back pain. J Korean Acad Rehabil Med. 2003. 27:568–574.

13. Hartmann KE, Ma C, Lamvu GM, Langenberg PW, Steege JF, Kjerulff KH. Quality of life and sexual function after hysterectomy in women with preoperative pain and depression. Obstet Gynecol. 2004. 104:701–709.

14. Fishbain DA, Cutler R, Rosomoff HL, Rosomoff RS. Chronic pain-associated depression: antecedent or consequence of chronic pain? A review. Clin J Pain. 1997. 13:116–137.

15. Waddell G. 1987 Volvo award in clinical sciences. A new clinical model for the treatment of low-back pain. Spine (Phila Pa 1976). 1987. 12:632–644.