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Background and Aims Post-hysterectomy pain is a major clinical problem which could lead to impaired physical function and quality of life. The continuation of acute pain into sub-acute pain is a significant risk factor for chronicity. The aim of this study was to evaluate the socio-demographic, surgical, and psychological risk factors for development of sub-acute pain lasting one month or more following hysterectomy.

Methods We conducted a prospective cohort study in 216 women who underwent abdominal or laparoscopic hysterectomy for benign conditions in KK Women’s and Children’s Hospital, Singapore. Preoperatively, socio-demographic characteristics, preexisting pain, psychological vulnerability, intra-operative variables, and postoperative pain intensity were assessed and recorded. Postoperative 4-month phone survey was conducted to assess the presence of sub-acute pain and functional impairment. Logistical regression analysis was used to identify the risk factors for sub-acute pain following hysterectomy.

Results Of 216 participants, 140 completed the study. The incidence of sub-acute pain after hysterectomy lasting one month and more was 32.9% (46/140). 93.4% women (43/46) with sub-acute pain had impact on their activities of daily living. Independent association factors for sub-acute pain at one month and more were higher education level, lower body weight, having had abdominal hysterectomy, higher pain scores during sitting 24 hours postoperatively. Area under ROC curve of the final multivariate model was 0.811.

Conclusions Sub-acute pain is not uncommon (32.9%) after hysterectomy. The risk factors for sub-acute pain will guide risk stratification and implementation of individualized therapies that could improve pain management and prevent progression to chronic post hysterectomy pain.