Medication Summary
Narcotic analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) can be used for pain relief in patients with ovarian cysts. NSAIDs, including ibuprofen and ketorolac, can be used to treat mild to moderate pain, while narcotic medications, such as morphine sulfate and oxycodone, are useful against moderate to severe pain.
As previously discussed, oral contraceptive pills (OCPs) protect against the development of functional ovarian cysts but cannot be used to resolve existing ones.
Opioid Analgesics
Class Summary
These agents are used to relieve moderate to severe pain. Pain relief is of paramount concern, but it must be remedied with agents chosen for the given clinical situation.
A review of opioid equivalents and conversions may be found in the following reference article:
http://emedicine.medscape.com/article/2138678-overview
Morphine sulfate (Astramorph, MS Contin, Avinza, Kadian, Duramorph, Infumorph, MorphaBond, Arymo ER)
Morphine sulfate is the drug of choice (DOC) for analgesia, owing to the drug's reliable and predictable effects, safety profile, and ease of reversibility with naloxone. Various intravenous (IV) doses are used; the drug is commonly titrated until the desired effect is obtained.
For chronic severe pain unremitting to alternative therapy, oral immediate–release and extended-release morphine sulfate may be warranted. Arymo ER is a morphine sulfate abuse-deterrent derivative.
Oxycodone (OxyContin, Oxecta, Roxicodone, Oxaydo, Xtampza ER)
Oxycodone is indicated for the relief of moderate to severe pain. It inhibits ascending pain pathways by binding to the opiate receptor. It alters the response to and perception of pain. It produces generalized CNS depression.
Analgesic Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
Class Summary
These agents are used for the relief of mild to moderate pain. They inhibit inflammatory reactions and pain by decreasing the activity of cyclo-oxygenase (COX), which results in decreased prostaglandin synthesis.
Ibuprofen (Advil, Motrin, Caldolor, Addaprin, Children's Motrin Jr Strength, EnovaRX-Ibuprofen, Genpril, Goodsense Ibuprofen Children's, I-Prin, IBU-200, Ibuprofen Comfort Pac, KS Ibuprofen, Neoprofen, Provil)
Ibuprofen is the DOC for patients with mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.
Indomethacin (Indocin,Tivorbex)
It is used for relief of mild to moderate pain; it inhibits inflammatory reactions and pain by decreasing the activity of COX, which results in a decrease of prostaglandin synthesis.
Naproxen (Naprosyn, Naprelan, Aleve, Anaprox, All Day Pain Relief, EC-Naprosyn, Equipto-Naproxen, Flanax Pain Relief, Goodsense Naproxen Sodium, Mediproxen, Naprelan, Naproderm)
Naproxen is used for relief of mild to moderate pain; it inhibits inflammatory reactions and pain by decreasing the activity of COX, which results in a decrease of prostaglandin synthesis.
Diclofenac (Voltaren, Cataflam XR, Zipsor, Cambia, Dyloject, Zorvolex)
Diclofenac inhibits prostaglandin synthesis by decreasing COX activity, which, in turn, decreases formation of prostaglandin precursors.
Ketoprofen (Active-Ketoprofen, Ketophene Radidpaq)
Ketoprofen is used for relief of mild to moderate pain and inflammation. Small dosages are indicated initially in small patients, elderly patients, and patients with renal or liver disease. Doses higher than 75 mg do not increase the therapeutic effects. Administer high doses with caution, and closely observe the patient's response.
Ketorolac (ReadySharp Ketorolac)
Ketorolac inhibits prostaglandin synthesis by decreasing the activity of COX, which results in decreased formation of prostaglandin precursors.
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A multilocular right ovarian cyst that is 24 cm in diameter. It is seen with the adjacent fallopian tube and uterus. The infundibulo-pelvic ligament carrying the ovarian artery and vein has been divided. Histology reported a mucinous cystadenocarcinoma of low malignant potential. Image courtesy of C. William Helm, MBBChir.
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Transabdominal sonogram of a multilocular right ovarian cyst that is 24 cm in diameter, with the adjacent fallopian tube and uterus. The infundibulo-pelvic ligament carrying the ovarian artery and vein has been divided. This sonogram demonstrates a large, complex cystic mass with vascularity within the septations. Red and blue colors show blood flow towards and away from the transducer. The resistive index was low. Histology reported a mucinous cystadenocarcinoma of low malignant potential. Courtesy Patrick O'Kane, MD.
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A multilocular right ovarian cyst that is 24 cm in diameter has been removed and cut open. It has a smooth surface and a multicystic internal structure. Image courtesy of C. William Helm, MBBChir.
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An ovarian cyst that underwent torsion (twisting of the vascular pedicle). The patient presented with a short history of severe lower abdominal pain. The twisted pedicle can be seen attached to the cyst, which has turned dusky due to ischemia. No viable epithelial lining was available for histologic diagnosis. Image courtesy of C. William Helm, MBBChir.
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Endovaginal sonogram shows a striking echogenic mass lateral to the uterus, with posterior acoustic shadowing giving a "tip-of-the-iceberg" appearance. This is pathognomonic for a dermoid cyst. Occasionally, this appearance may be mistaken for a gas-filled bowel. Courtesy of Patrick O'Kane, MD.
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A dermoid cyst (mature cystic teratoma) after opening the abdomen. Note the yellowish color of the contents seen through the wall. Image courtesy of C. William Helm, MBBChir.
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A dermoid cyst has been opened in the operating room to reveal copious sebaceous fluid. This cyst also contained hair. Image courtesy of C. William Helm, MBBChir.
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A dermoid cyst has been opened and contains teeth. Image courtesy of C. William Helm, MBBChir.
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Theca-lutein cysts replacing an ovary in a patient with a molar pregnancy. Despite their size these cysts are benign and usually resolve after treatment of the underlying disease. Image courtesy of C. William Helm, MBBChir.
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Cross-section of a clear cell carcinoma of the ovary. Note the cystic spaces intermingled with solid areas. Image courtesy of C. William Helm, MBBChir.
