High Catastrophizing in Subjects With Painful Mesh Complications Leads to Worse Outcomes

Abstract

Objective: To identify the rate of catastrophizing in a cohort of subjects with chronic pain after self-reported mesh complications and identify interactions of catastrophization with other patient factors, such as age, number of pelvic surgeries, and intent to sue. Catastrophizing has been shown to be a risk factor for chronicity of pain, disability, and depression.

Methods: The pain catastrophization scale (PCS) identifies patients likely to have an exaggerated, negative thought process in response to pain. Subjects throughout the United States with self-described complications of vaginal mesh completed an internet-based, anonymous survey, featuring multiple standardized questionnaires including the PCS and female Genitourinary Pain Index (GUPI). A previously defined threshold score of >30 on the PCS defined high-pain catastrophizing. Statistical analysis was performed using χ² test and t test for categorical and continuous variables, respectively.

Results: Ninety of 167 participants (54%) were found to have high-pain catastrophizing. Age, intent to sue, or number of previous pelvic surgeries did not correlate with high catastrophization. Subjects who catastrophized were significantly more likely to have a higher overall GUPI score (35.0 vs 30.5, P < .001), which came from increases in the pain (18.0 vs 14.2, P < .001) and quality of life (11.0 vs 9.5, P < .001) GUPI subdomains.

Conclusion: Subjects with self-described mesh complications have a high rate of pain catastrophizing associated with significantly worse quality of life and higher pain. Identifying high catastrophizing patients in the setting of chronic pelvic pain from mesh complications may help guide treatment and be an indicator for early or adjunctive psychosocial intervention.