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Women Undergoing Hysterectomies Don’t Get Enough Pain Relief

April 10, 2012
Potofen (Ibuprofen) 200mg capsule. ‪中文(繁體)‬:...

Potofen (Ibuprofen) 200mg capsule. ‪中文(繁體)‬: 異丁苯丙酸 (布洛芬) 200毫克 膠囊 (Photo credit: Wikipedia)

I have always said that if men had to have their testicles removed regularly, they wouldn’t be sent home from the hospital with advice to take Tylenol and ibuprofen, but women who have hysterectomies are sent home with just that advice, and guess what?  They are still in pain:

For some women having a hysterectomy or other gynecologic surgery, at-home plans for pain relief may not be good enough, according to a new study.

Of 127 women who had their surgeries at one Utah medical center, about half told researchers their pain control was falling short three days after leaving the hospital.

Two weeks later, 23 percent of women whose surgery had involved cutting into the abdomen were still feeling their pain wasn’t controlled — as were five percent of those who had vaginal surgery.

Even more were still in need of narcotic painkillers at the two-week mark: one-third of women who’d had abdominal surgery, and 10 percent of those who’d had vaginal surgery.

The study, reported in the journal Obstetrics & Gynecology, is a rare inquiry into how women fare during at-home recovery from gynecologic surgery.

“It’s just amazingly understudied,” said lead researcher Dr. Ingrid Nygaard, of the University of Utah School of Medicine in Salt Lake City.

One reason it’s so important to understand what goes on during home recovery is that hospital stays are now much shorter than they were years ago.

The women in this study were discharged from the hospital an average of one or two days after surgery, depending on whether it was vaginal or abdominal. Most often, the surgery was a hysterectomy (removal of the uterus) or a procedure to correct prolapse — when weakened tissue in the pelvis allows one or more organs to protrude into the vagina.

All of the women kept diaries at home to record their pain control after surgery.

Based on the results, Nygaard’s team concluded pain relief was “suboptimal” for some women.

“I’m not advocating more narcotics,” Nygaard said, referring to the powerful painkillers, like hydrocodone and oxycodone, that surgery patients typically need for a period of time after their procedures.

But, she said, there’s a need for more research into how to best control women’s pain after gynecologic surgery.

“We can see that it’s a problem. Now we need to see what helps,” Nygaard said.

For now, better patient education on pain control might make a difference, she said. Some women, for example, might find that it’s best to take non-narcotic painkillers — namely, non-steroidal anti-inflammatory drugs like ibuprofen — “round-the-clock,” and save narcotics for more-occasional use.

Ibuprofen taken “round-the clock,” isn’t a healthy option, and this aversion to narcotics simply seems illogical:  why take ibuprofen around the clock but ignore pain relievers that work better simply because of stigma that surrounds them?  This illogical approach is based on either downplaying a woman’s pain after surgery, a specific surgery of the reproductive tract, or simply saying they have to take lots more ibuprofen.   If women’s pain is still uncontrolled, why the bias against medicating it?

Gynecologists, I have found, are a particularly misogynistic group, often denying women adequate pain relief under the auspices of ignoring women’s pain, as is stated above, that pain after gynecologic surgery is both understudied and underestimated or simply advocating toughing it out.

When I had surgery to remove an ectopic pregnancy,  a botched maneuver from start to finish that left me permanently scarred, the initial misdiagnosis of the ectopic pregnancy and the subsequent diagnosis of surgery-caused nerve damage were both based on physicians’ mistakes regarding pain levels, namely that if they had adequately addressed my pain levels, they would have come to a correct clinical diagnosis. Since ectopic pregnancies are the leading cause of maternal mortality in the first trimester, or the top reason women die in childbirth in the first trimester, one might assume that this condition would be readily investigated.  In fact, it is not, and I suspect that the number of deaths caused by undiagnosed ectopic pregnancies would decrease if the medical establishment investigated women’s pain symptoms in a more scientific method, as opposed to the old emotional standby currently used: “it doesn’t hurt that bad…”  This emotional perception of women’s pain causes fatalities, injuries, and is based on bad medical decisions.

Is this a story of doctors ignoring clinical findings regarding clinical findings in the face of direct evidence that leads to substandard medical care for women?  Sure sounds like it, and it leads to pain and suffering. Gynecological misogyny is the most prevalent form of gynecological surgery apparently.

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