Myofascial Pain in Hysterectomy patients
The study suggests that myofascial pelvic pain must be considered in the evaluation of chronic pelvic pain (CPP), especially in surgical candidates.

The purpose was to assess the prevalence of myofascial pain in women undergoing uncomplicated minimally invasive hysterectomy for chronic pelvic pain, to identify clinical and demographic factors associated with preoperative myofascial pain, and examine the association between myofascial pain and postoperative pain in hysterectomy patients.

Three hundred and fifty-three adult women who underwent uncomplicated minimally invasive hysterectomy were enrolled. All women underwent a preoperative pelvic floor exam. Myofascial pain was diagnosed as tenderness and reproduction of pain symptoms in at least 2 of 6 pelvic floor muscles.

- Of the 353 women who underwent a hysterectomy, the prevalence of myofascial pain was 42.7%.

- Women with myofascial pain were more likely younger, Caucasian, sexually active, and with comorbid pain conditions.

- Patients with myofascial pain utilized a greater number of adjuvant pain medications prior to surgery including opiates but were only half as likely to use muscle relaxants for preoperative pain control.

- Contrastingly, in women without myofascial pain before surgery, controlled substances such as opiates and benzodiazepines were used at a three-fold lower frequency.

- Postoperative pain score was higher in patients with myofascial pain with 37% reporting a VAS greater than 5 at the routine postoperative visit compared to only 1% of patients without myofascial pain.

In conclusion, women with myofascial pelvic pain utilize a greater amount of pain medication preoperatively and have higher pain scores postoperatively. Identification of these high-risk patients before surgery may improve pre and postoperative pain management with a multimodal therapy approach.