Non-invasive treatments of adhesion-related chronic abdominal and pelvic pain after surgery: a systematic review.

B.A.W. van den Beukel1
R. de Ree1
H. van Goor1 
S. van de Wal2
R.P.G. ten Broek1
1. Department of Surgery, Radboud University Medical Center
Nijmegen, The Netherlands
2. Department of Anesthesiology, Radboud University Medical Center
Nijmegen, The Netherlands
Corresponding Author:
Richard ten Broek
Radboud University Nijmegen Medical Center
Department of Surgery
P.O. Box 9101
6500 HB Nijmegen, the Netherlands
E-mail: Richard.tenbroek@radboudumc.nl
 
Abstract:
Background and aims:
Chronic abdominal pain after abdominal surgery negatively impacts quality of life in millions of patients, and often results in opioid dependency. Adhesions are a common cause of chronic pain after surgery. Although operative treatment by adhesiolysis can relief symptoms in selected patients, many patients require non-operative treatments. The aim of this study is to evaluate the evidence for non-operative treatments in chronic pain associated with adhesions after surgery.
Methods:
A search was conducted in Pubmed, Embase and Central by two independent researchers. Studies with patients suffering from chronic post-operative pain related to adhesions were included. Primary outcome was relief in pain score at one year follow-up. Secondary outcomes were efficacy at a minimum of three months in pain relief, quality of life, and return to daily activity. Data extraction and analysis of quality were done by these researchers independently.
Results
Searches identified 3022 unique citations. 4 studies were included in this review, one randomized trial, a cohort study and two case reports. The primary outcome was not reported in the trial or cohort study. One of the case reports had 1 year follow-up. In a small trial (N=18), pregabalin significantly reduced pain scores at three months follow-up on an 11-point Likert-scale. Half of patients experienced side effects of pregabalin.
In one cohort study (N=17), sacral nerve modulation was provided to all patients with a history of pelvic surgery, with successful reduction in pain score in 47%. These patients were followed up to 36 months. No complications were reported.
Two case reports, presented abdominal plane neuron stimulation and soft tissue mobilization as a treatment for adhesion- related pain.
Conclusions
There is marked paucity in literature on non-operative treatments for adhesion related pain. Pregabaline and nerve modulation seem promising in small pilot studies. With increasing evidence of adhesions as a separate entity causing chronic pain, and new capabilities to diagnose adhesions non-invasively; research in this specific patient group is becoming increasingly relevant.

NON-INVASIVE TREATMENT OF ADHESION-RELATED CHRONIC ABDOMINAL AND PELVIC PAIN AFTER SURGERY: A SYSTEMATIC REVIEW