Prevalence and risk factors for chronic pain following cesarean section: a prospective study

Juying Jin, Lihua Peng, Qibin Chen, Dong Zhang, Li Ren, Peipei Qin, Su Min, Juying Jin, Lihua Peng, Qibin Chen, Dong Zhang, Li Ren, Peipei Qin, Su Min

Abstract

Background: Chronic post-surgical pain (CPSP) remains a major clinical problem which may be associated with impaired activities of daily life and decreased health-related quality of life. Although cesarean section is one of the most commonly performed operations, chronic pain after cesarean delivery has not been well-studied. The purpose of this prospective study was to assess the incidence and risk factors of chronic pain at 3, 6 and 12 months after cesarean delivery.

Methods: We prospectively investigated preoperative demographic and psychological factors, intraoperative clinical factors, and acute postoperative pain in a cohort of 527 women undergoing cesarean section. The women were interviewed and completed pain questionnaires after 3, 6 and 12 months. Questions were about pain intensity, frequency, and location, as well as medical treatment and impact on daily living.

Results: The incidence of CPSP at 3, 6 and 12 months after cesarean section was 18.3 %, 11.3 % and 6.8 %, respectively. Most of the women with CPSP experienced mild pain at rest. The incidence of moderate and severe pain on movement was high at 3 month, and then has a significant decrease at 6 and 12 months. CPSP had a negative influence on the activities of daily living. Independent predictors of CPSP at 3 months included higher average pain intensity on movement within 24 h postoperatively, preoperative depression, and longer duration of surgery. At 6 months, more severe pain during movement within 24 h of surgery and preoperative depression were predictive of pain persistence. And 12 months after surgery, only higher average pain score on movement within 24 h following cesarean section was found to be significant associated with CPSP. The three models all showed moderate discrimination and good calibration for the prediction of CPSP at 3, 6 and 12 months postoperatively.

Conclusions: CPSP was not rare in women undergoing cesarean section. Patients with more intense of acute postoperative pain on movement, preoperative depression, and longer surgical time had greater risk for CPSP following surgery.

Keywords: Cesarean section; Chronic post-surgical pain; Postoperative pain; Risk factors.

References

    1. International Association for the Study of Pain (IASP) Subcommittee on Taxonomy Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Pain. 1986;24(Suppl):S1–S226.
    1. Macrae WA, Davies HT. Chronic postsurgical pain. In: Crombie IK, Croft PR, Linton SJ, SeResche L, Von Korff M, editors. Epidemiology of Pain. Seattle: IASP Press; 1999. pp. 125–42.
    1. Macrae WA. Chronic post-surgical pain: 10 years on. Br J Anaesth. 2008;101:77–86. doi: 10.1093/bja/aen099.
    1. Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367:1618–25. doi: 10.1016/S0140-6736(06)68700-X.
    1. Courtney CA, Duffy K, Serpell MG, O’Dwyer PJ. Outcome of patients with severe chronic pain following repair of groin hernia. Br J Surg. 2002;89:1310–6. doi: 10.1046/j.1365-2168.2002.02206.x.
    1. Kumar S, Wilson RG, Nixon SJ, Macintyre IMC. Chronic pain after laparoscopic and open mesh repair of groin hernia. Br J Surg. 2002;89:1476–81. doi: 10.1046/j.1365-2168.2002.02260.x.
    1. Betrán AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21:98–113. doi: 10.1111/j.1365-3016.2007.00786.x.
    1. Duan T. Present situation and some thoughts of caesarean section. Chinese J Practical Gynecol Obstet. 2008;24:721–3.
    1. Zhang J, Troendle J, Reddy UM, Laughon SK, Branch DW, Burkman R, et al. Contemporary cesarean delivery practice in the United States. Am J Obstet Gynecol. 2010;203(326):e1–10.
    1. Qian X, Smith H, Liang H, Liang J, Garner P. Evidence-informed obstetric practice during normal birth in China: trends and influences in four hospitals. BMC Health Serv Res. 2006;6:29. doi: 10.1186/1472-6963-6-29.
    1. World Health Organization Appropriate technology for birth. Lancet. 1985;2:436–7.
    1. Nikolajsen L, Sorensen HC, Jensen TS, Kehlet H. Chronic pain following caesarean section. Acta Anaesthesiol Scand. 2004;48:111–6. doi: 10.1111/j.1399-6576.2004.00271.x.
    1. Sng BL, Sia AT, Quek K, Woo D, Lim Y. Incidence and risk factors for chronic pain after caesarean section under spinal anaesthesia. Anaesth Intensive Care. 2009;37:748–52.
    1. Declercq E, Cunningham DK, Johnson C, Sakala C. Mothers’ reports of postpartum pain associated with vaginal and cesarean deliveries: results of a national survey. Birth. 2008;35:16–24. doi: 10.1111/j.1523-536X.2007.00207.x.
    1. Kainu JP, Sarvela J, Tiippana E, Halmesmäki E, Korttila KT. Persistent pain after caesarean section and vaginal birth: a cohort study. Int J Obstet Anesth. 2010;19:4–9. doi: 10.1016/j.ijoa.2009.03.013.
    1. Eisenach JC, Pan PH, Smiley R, Lavand’homme P, Landau R, Houle TT. Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression. Pain. 2008;140:87–94. doi: 10.1016/j.pain.2008.07.011.
    1. Eisenach JC, Pan P, Smiley RM, Lavand’homme P, Landau R, Houle TT. Resolution of pain after childbirth. Anesthesiology. 2013;118:143–51. doi: 10.1097/ALN.0b013e318278ccfd.
    1. Liu TT, Raju A, Boesel T, Cyna AM, Tan SG. Chronic pain after caesarean delivery: an Australian cohort. Anaesth Intensive Care. 2013;41:496–500.
    1. Feng XL, Xu L, Guo Y, Ronsmans C. Factors influencing rising caesarean section rates in China between 1988 and 2008. Bull World Health Organ. 2012;90:30–9. doi: 10.2471/BLT.11.090399.
    1. Masselin-Dubois A, Attal N, Fletcher D, Jayr C, Albi A, Fermanian J, et al. Are psychological predictors of chronic postsurgical pain dependent on the surgical model? A comparison of total knee arthroplasty and breast surgery for cancer. J Pain. 2013;14:854–64. doi: 10.1016/j.jpain.2013.02.013.
    1. Hegarty D, Shorten G. Multivariate prognostic modeling of persistent pain following lumbar discectomy. Pain Physician. 2012;15:421–34.
    1. Bruce J, Thornton AJ, Powell R, Johnston M, Wells M, Heys SD, et al. Recovery Study Group. Psychological, surgical, and sociodemographic predictors of pain outcomes after breast cancer surgery: a population-based cohort study. Pain. 2014;155:232–43. doi: 10.1016/j.pain.2013.09.028.
    1. Qiu JY, Wang ZC, Luo LM, Mei LP. Clinical application of the Edinburgh postnatal depression scale. Shanghai Arch Psychiatry. 2001;13:219–21.
    1. Bunevicius A, Kusminskas L, Pop VJ, Pedersen CA, Bunevicius R. Screening for antenatal depression with the Edinburgh Depression Scale. J Psychosom Obstet Gynaecol. 2009;30:238–43. doi: 10.3109/01674820903230708.
    1. Zheng XH, Shu L, Zhang AL, Huang GL. Test results of the State Trait Anxiety Inventory in Changchun city. Chin Ment Health J. 1993;7:60–2.
    1. Grant KA, McMahon C, Austin MP. Maternal anxiety during the transition to parenthood: a prospective study. J Affect Disord. 2008;108:101–11. doi: 10.1016/j.jad.2007.10.002.
    1. Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore. 1994;23:129–38.
    1. Mendoza TR, Chen C, Brugger A, Hubbard R, Snabes M, Palmer SN, et al. The utility and validity of the modified brief pain inventory in a multiple-dose postoperative analgesic trial. Clin J Pain. 2004;20:357–62. doi: 10.1097/00002508-200409000-00011.
    1. Lavand’homme P. The progression from acute to chronic pain. Curr Opin Anaesthesiol. 2011;24:545–50. doi: 10.1097/ACO.0b013e32834a4f74.
    1. Bruce J, Drury N, Poobalan AS, Jeffrey RR, Smith WC, Chambers WA. The prevalence of chronic chest and leg pain following cardiac surgery: a historical cohort study. Pain. 2003;104:265–73. doi: 10.1016/S0304-3959(03)00017-4.
    1. Nienhuijs S, Staal E, Strobbe L, Rosman C, Groenewould H, Bleichrodt R. Chronic pain after mesh repair of inguinal hernia: a systematic review. Am J Surg. 2007;194:394–400. doi: 10.1016/j.amjsurg.2007.02.012.
    1. Callesen T, Bech K, Kehlet H. Prospective study of chronic pain after groin hernia repair. Br J Surg. 1999;86:1528–31. doi: 10.1046/j.1365-2168.1999.01320.x.
    1. Katz J, Jackson M, Kavanagh BP, Sandler AN. Acute pain after thoracic surgery predicts long-term postthoracotomy pain. Clin J Pain. 1996;12:50–5. doi: 10.1097/00002508-199603000-00009.
    1. Karanikolas M, Aretha D, Tsolakis I, Monantera G, Kiekkas P, Papadoulas S. Optimized perioperative analgesia reduces chronic phantom limb pain intensity, prevalence, and frequency. Anesthesiology. 2011;114:1144–54. doi: 10.1097/ALN.0b013e31820fc7d2.
    1. Lahtinen P, Kokki H, Hynynen M. Pain after cardiac surgery: a prospective cohort study of 1-year incidence and intensity. Anesthesiology. 2006;105:794–800. doi: 10.1097/00000542-200610000-00026.
    1. De Kock M. Expanding our horizons: transition of acute postoperative pain to persistent pain and establishment of chronic post surgical pain services. Anesthesiology. 2009;111:461–3. doi: 10.1097/ALN.0b013e3181afde28.
    1. Vermelis JM, Wassen MM, Fiddelers AA, Nijhuis JG, Marcus MA. Prevalence and predictors of chronic pain after labor and delivery. Curr Opin Anaesthesiol. 2010;23:295–9. doi: 10.1097/ACO.0b013e32833853e8.
    1. Andersson L, Sundström-Poromaa I, Wulff M, Aström M, Bixo M. Implications of antenatal depression and anxiety for obstetric outcome. Obstet Gynecol. 2004;104:467–76. doi: 10.1097/01.AOG.0000135277.04565.e9.
    1. Hinrichs-Rocker A, Schulz K, Järvinen I, Lefering R, Simanski C, Neugebauer EA. Psychosocial predictors and correlates for chronic post-surgical pain (CPSP) - a systematic review. Eur J Pain. 2009;13:719–30. doi: 10.1016/j.ejpain.2008.07.015.
    1. Hobson JA, Slade P, Wrench IJ, Power L. Preoperative anxiety and postoperative satisfaction in women undergoing elective caesarean section. Int J Obstet Anesth. 2006;15:18–23. doi: 10.1016/j.ijoa.2005.05.008.
    1. Peters ML, Sommer M, de Rijke JM, Kessels F, Heineman E, Patijn J, et al. Somatic and psychologic predictors of long-term unfavorable outcome after surgical intervention. Ann Surg. 2007;245:487–94. doi: 10.1097/01.sla.0000245495.79781.65.
    1. Kalso E, Mennander S, Tasmuth T, Nilsson E. Chronic post-sternotomy pain. Acta Anaesthesiol Scand. 2001;45:935–9. doi: 10.1034/j.1399-6576.2001.450803.x.

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