Analgesia in patients with adhesion-related chronic abdominal and pelvic pain after surgery: a systematic review

Abstract

Background and objective

Adhesions are the most common cause of chronic abdominal pain after surgery. Surgical adhesiolysis can relieve symptoms in selected patients, but many require other treatments. The aim of this study is to evaluate analgesic treatments other than abdominal surgery in chronic pain related to adhesions.

Database and data treatment

A search was conducted in PubMed, Embase, and Central. Studies with patients suffering from chronic postoperative pain related to adhesions and undergoing all types’ analgesic treatment were included. The primary outcome was the number of patients who improved in pain at long-term follow-up (at least 1 year). Secondary outcomes included improvement in pain at 3 months follow-up, quality of life, and physical functioning.

Results

Searches identified 3022 citations. Four studies were included, one trial, one cohort study, and two case reports. The primary outcome was not reported. In a small trial (n = 18) pregabalin tended to have a benefit over placebo improving pain at 3 months. In the cohort study, 17 patients with chronic pelvic pain underwent a trial of sacral nerve stimulation. Eight patients who responded positively received an implanted device for continuous modulation, reporting sustainable improvement during follow-up (range: 6–36 months). One case report described improved pain at 6 months with trans-abdominis plane stimulation. The second report described improvement of physical function with manual therapy at long-term follow-up.

Conclusions

Low level of evidence is available regarding analgesic treatments of chronic abdominal and pelvic pain related to adhesions. The benefit of pregabalin is doubtful; nerve modulation is promising in a selected group.

Highlights

• Adhesions are a frequent cause of chronic abdominal and pelvic pain after surgery.

• Many patients are not good candidates for surgery (Adhesiolysis) or have relapses of pain.

• There is an important knowledge gap regarding non-surgical analgesic treatment.

• Analgesia in adhesion-related chronic abdominal pain after surgery.

Keywords:

• Pain management
• adhesions related pain
• chronic abdominal pain
• postoperative pain
• analgesia

Disclosure statement

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.