Do patients with central sensitivity syndromes have poor subjective outcomes despite anatomical cure from pelvic organ prolapse surgery?

The relationship between symptom severity, bother and psychological factors in women with pelvic organ prolapse: A cross‐sectional observational study

“…49 Furthermore, CSS, as measured by the central sensitivity inventory 50 were found to be predictors of poor outcomes in women undergoing prolapse surgery. 19 Women with CSS were more likely to be bothered by unresolved POP symptoms despite objective improvement in their prolapse. These findings on altered central processing in women with POP may provide a link to explain why women with higher psychological distress experience more prolapse bother despite having less severe POP anatomically.…”

“…Psychological factors are acknowledged to play a key role in the development of central sensitivity syndromes (CSS) 48 which have been identified in 32% of women with POP attending a gynecology clinic 49 . Furthermore, CSS, as measured by the central sensitivity inventory 50 were found to be predictors of poor outcomes in women undergoing prolapse surgery 19 . Women with CSS were more likely to be bothered by unresolved POP symptoms despite objective improvement in their prolapse.…”

“…17 The presence of psychological factors has been linked to poorer outcomes with conservative and surgical management for POP and incontinence. 18,19 Catastrophizing is associated with negative thoughts and expectations in pain patients and is considered to be a maladaptive coping strategy, contributing to fear-avoidance beliefs and hypervigilance. 14,20 In the context of POP, the tendency to catastrophize could explain why some women are highly bothered by POP in the presence of minimal anatomical descent.…”

“…Those seeking assistance for POP had higher levels of depression and a lower QOL 17 . The presence of psychological factors has been linked to poorer outcomes with conservative and surgical management for POP and incontinence 18,19 . Catastrophizing is associated with negative thoughts and expectations in pain patients and is considered to be a maladaptive coping strategy, contributing to fear‐avoidance beliefs and hypervigilance 14,20 .…”

Pelvic organ prolapse: The lived experience

“…Sleep disturbance has been associated with CS in research on irritable bowel syndrome [ 45 ], migraine [ 46 ] and fibromyalgia [ 47 ], which were co-morbidities for some of the participants. It has been demonstrated that women with CSI are less likely to have favourable outcomes after POP surgery [ 48 ] and research in chronic pain patients with CSI has shown that treatment strategies aimed at targeting local structures are typically of little value in those with predominant CS bother [ 49 ]. This research suggests a more “central” or psychosocially-informed approach (stress management, sleep management, graded activity/graded exercise therapy, graded exposure and a recognition of the biopsychosocial perspective) targeting brain and top-down mechanisms seems warranted for treatment of CS.…”