RAMB Novembro/Dezembro 2015

arqui

ABT

508

ssoc

ras

2015; 61(6):507-518

Given the above, the symptoms of this painful gyne-

cological condition interfere with the professional and

personal life of patients and, therefore, control of this

variable is essential in order to provide a better quality of

life for such women. As such, this study aimed to evalu-

ate the levels of pain in women with endometriosis, fo-

cusing on the influence of conventional treatment in con-

trolling this variable.

ethods

A literature search was conducted in September 2013 in

the Medline/PubMed databases without restriction by

period, using the keywords “endometriosis” and “inten-

sity of pain”. PubMed was the database of choice for this

systematic review as it is more comprehensive, used in-

ternationally in health care research and, therefore, pro-

vides the most complete indexing of scientific studies.

119 articles were found and 27 were retrieved and ana-

lyzed in full. The inclusion criteria for selection of the ar-

ticles were: 1) those closely related to the theme, with se-

lection based on titles and/or abstracts; 2) articles written

in English or Portuguese; 3) the possibility of obtaining

the full version of the article; 4) those that were original/

research articles. In endometriosis, conventional treat-

ment includes laparoscopic surgery and pharmacologi-

cal treatment. The title and/or abstract of 27 articles pre-

sented information about the method of treatment used

to control the symptoms of pain caused by endometrio-

sis. Review articles or letters to the editor were excluded,

as well as those without any relationship with the subject

of the review, and those that did not offer access to the

full article and those published in other foreign languag-

es. The reference lists of articles identified in the electron-

ic search were also reviewed in order to find potentially

important studies for inclusion in this literature review.

The selection of articles included in the review was car-

ried out by a single examiner, following the previously de-

fined criteria. Ten other references were also used to help

compose the introduction and discussion of the results.

esults

After applying the pre-established inclusion and exclu-

sion criteria, 27 studies that evaluated pain levels in pa-

tients with endometriosis were selected for the develop-

ment of this literature review.

6-32

Nine studies assessed the contribution of surgery to re-

duce pain levels in patients with endometriosis

7-9,11,14,16,21,25,29

and one assessed the combination of surgical and drug treat-

ments (combined oral contraceptives – COC).

The indi-

vidual values and frequency for each type of pain before

and after the surgical procedure are presented in Tables 1

and 2. Also, Garry et al.

showed that of the 53 patients

with dysmenorrhea, 43 reported improvement in this symp-

tom 4 months after surgery, while 4 did not notice chang-

es and 6 reported worsening after surgery. Non-menstru-

al pelvic pain was reported by 48 women, 34 of which

reported an improvement after surgery, with four report-

ing no change and 10 feeling worse. Dyspareunia was re-

ported by 41 patients, 32 of which reported improvement,

while 5 and 4 patients reported no change and worsen-

ing of symptoms, respectively. Rectal pain was cited by

41 patients with 35 of them reporting improvement af-

ter surgery.

Other studies aimed at checking if there was a de-

crease in pain levels after surgery were performed by Fab-

bri et al.

and Jdrzejczak et al.

The first study used the

McGill Pain Questionnaire (MPQ) in 55 women with se-

vere endometriosis who underwent laparoscopy. The pain

intensity ratio before surgery was 3, falling to 1 after sur-

gery (6 months), that is, the intensity of the pain signif-

icantly decreased after laparoscopic treatment of endo-

metriosis (p<0.0005). A significant reduction was also

observed (p<0.05) on all individual pain indexes; how-

ever, 18.2% of those women showed no improvement in

the symptoms of pain after laparoscopic surgery. Possi-

ble explanations for this include recurrence of the dis-

ease after surgery, incomplete excision of endometriot-

ic lesions or pain unrelated to endometriosis. Jdrzejczak

et al.

evaluated the effects of pre-sacral neurectomy in

the treatment of CPP in 23 women, 16 of whom had en-

dometriosis, while 7 did not. The symptoms of pain eval-

uated were dysmenorrhea, CPP and dyspareunia, with

intensity determined by the visual analogue scale (VAS)

before surgery, and 3 and 12 months postoperatively. The

results show a significant improvement in pain symp-

toms after three months and this remained significant

12 months postoperatively. Furthermore, at the end of

the study 79% of the patients reported general satisfac-

tion in relation to pain relief.

The referred studies have shown that the severity of

all kinds of pain was diminished after surgery, as well as

the prevalence of such, thus demonstrating the effective-

ness of surgery for pain relief, and consequently for the

quality of life of women with endometriosis.

Seventeen studies published in the literature evalu-

ated the use of drugs to treat pain associated with endo-

metriosis.

6,10,12,13,15,17-20,22-24,26-28,31,32

The main results of these

studies are summarized in Table 3.