Leg pain in women with endometriosis and effect of laparoscopic surgery

Introduction. In addition to dysmenorrhea, dyspareunia, and subfertility, pain in the lower extremities has been described to be a further complaint in women affected by endometriosis, and lysis of nerve entrapment was thought to be associated with amelioration of leg pain. Objectives. We conducted this clinical trial, to compare the prevalence of cyclic leg pain and pain intensity, quantified according to a visual analog scale (VAS) score between women with endometriosis and without endometriosis. In addition, we evaluated the effect of laparoscopic surgery - without preparation and decompression of nerve tissue- on these symptoms. Patients and Methods. Forty-four women with endometriosis and 58 controls were included in this prospective, controlled clinical study at the University Hospital Vienna, a tertiary referral center. Women were asked to fill-out questionnaires the day before and 6-9 weeks after laparoscopy. Results. Before surgery, significantly more women were affected by leg pain in the study group, compared to the control group (45.5% and 25.9%, respectively, p = 0.039). Preoperative VAS scores for leg pain, however, were not significantly higher within the endometriosis group compared to the control group. In the endometriosis group, as well as in the control group, we found a clear and significant improvement in leg pain intensity after the laparoscopy compared to what was reported on the preoperative VAS scores (both p<0.001). The average improvement in the VAS score for leg pain was 4.2 (95% CI: 3.4-5.1) in the study group and 3.0 (95% CI: 2.0-4.1) in the control group. The mean difference in the VAS score for pain reduction between the study group and the control group was 1.20 (95% CI: -0.23-2.62), which was not statistically significant (p = 0.097). Conclusion. The prevalence of leg pain is increased in endometriosis, while leg pain intensity is not, compared to women without endometriosis. Laparoscopic exploration—even without preparation and decompression of nerve tissue—is associated with an improvement in pain intensity in women with endometriosis, as well as in the group without endometriosis.