Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression

University of Geneva, Genève, Geneva, Switzerland
Pain (Impact Factor: 5.84). 10/2008; 140(1):87-94. DOI: 10.1016/j.pain.2008.07.011
Source: PubMed

ABSTRACT Cesarean delivery rates continue to increase, and surgery is associated with chronic pain, often co-existing with depression. Also, acute pain in the days after surgery is a strong predictor of chronic pain. Here we tested if mode of delivery or acute pain played a role in persistent pain and depression after childbirth. In this multicenter, prospective, longitudinal cohort study, 1288 women hospitalized for cesarean or vaginal delivery were enrolled. Data were obtained from patient interviews and medical record review within 36 h postpartum, then via telephone interviews 8 weeks later to assess persistent pain and postpartum depressive symptoms. The impact of delivery mode on acute postpartum pain, persistent pain and depressive symptoms and their interrelationships was assessed using regression analysis with propensity adjustment. The prevalence of severe acute pain within 36 h postpartum was 10.9%, while persistent pain and depression at 8 weeks postpartum were 9.8% and 11.2%, respectively. Severity of acute postpartum pain, but not mode of delivery, was independently related to the risk of persistent postpartum pain and depression. Women with severe acute postpartum pain had a 2.5-fold increased risk of persistent pain and a 3.0-fold increased risk of postpartum depression compared to those with mild postpartum pain. In summary, cesarean delivery does not increase the risk of persistent pain and postpartum depression. In contrast, the severity of the acute pain response to childbirth predicts persistent morbidity, suggesting the need to more carefully address pain treatment in the days following childbirth.

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Available from: Richard M Smiley, Aug 16, 2015
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    • "However, due to selective inclusion and somewhat artificial conditions of RCTs [e.g., rescue intravenous (i.v.) patient-controlled analgesia], these rarely represent typical everyday care and the normal course of acute post-operative pain. Next to the unpleasantness of pain, insufficiently treated acute pain after CS can contribute to long-term negative outcomes such as chronic post-operative pain (Nikolajsen et al., 2004; Eisenach et al., 2008; Kainu et al., 2010), a threefold risk of developing postpartum depression, a risk for delayed breastfeeding and a feeling of guilt if the woman is not able to care for her newborn (Eisenach et al., 2008; Woods et al., 2012). Persistent maternal pain and depression have also been demonstrated to impair cognitive processes and might induce later behavioural disturbances in the child (Wrate et al., 1985; Grace et al., 2003; Evans et al., 2007). "
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    ABSTRACT: BackgroundA large cohort study recently reported high pain scores after caesarean section (CS). The aim of this study was to analyse how pain after CS interferes with patients' activities and to identify possible causes of insufficient pain treatment.Methods We analysed pain scores, pain-related interferences (with movement, deep breathing, mood and sleep), analgesic techniques, analgesic consumption, adverse effects and the wish to have received more analgesics during the first 24 h after surgery. To better evaluate the severity of impairment by pain, the results of CS patients were compared with those of patients undergoing hysterectomy.ResultsCS patients (n = 811) were compared with patients undergoing abdominal, laparoscopic-assisted vaginal or vaginal hysterectomy (n = 2406, from 54 hospitals). Pain intensity, wish for more analgesics and most interference outcomes were significantly worse after CS compared with hysterectomies. CS patients with spinal or general anaesthesia and without patient-controlled analgesia (PCA) received significantly less opioids on the ward (62% without any opioid) compared with patients with PCA (p < 0.001). Patients with PCA reported pain-related interference with movement and deep breathing between 49% and 52% compared with patients without PCA (between 68% and 73%; p-values between 0.004 and 0.013; not statistically significant after correction for multiple testing).Conclusion In daily clinical practice, pain after CS is much higher than previously thought. Pain management was insufficient compared with patients undergoing hysterectomy. Unfavourable outcome was mainly associated with low opioid administration after CS. Contradictory pain treatment guidelines for patients undergoing CS and for breastfeeding mothers might contribute to reluctance of opioid administration in CS patients.
    European journal of pain (London, England) 12/2014; DOI:10.1002/ejp.619 · 3.22 Impact Factor
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    • "Therefore , as a risk factor for chronic pain (Lavand&apos;homme, 2010; Vermelis et al., 2010), insufficient post- Caesarean pain control could represent a serious public health problem in the future. Numerous studies have tested the value of clinical predictors to detect women at risk for acute and/or chronic pain after childbirth (Granot et al., 2003; Pan et al., 2006; Strulov et al., 2007; Eisenach et al., 2008), and several approaches to evaluate central pain sensitization , excitatory and inhibitory pain modulation, have been evaluated (Granot, 2009; Werner et al., 2010; Wilder-Smith, 2011). We hypothesized that women's residual hypersensitivity [or scar hyperalgesia (SHA)] from a previous Caesarean delivery can be used as a marker for long-term changes of pain modulation . "
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    ABSTRACT: BACKGROUND: Over 1.4 million Caesarean deliveries are performed annually in the United States, out of which 30% are elective repeat procedures. Post-operative hyperalgesia is associated with an increased risk for persistent post-surgical pain; however, there are no data on whether residual scar hyperalgesia (SHA) from a previous Caesarean delivery (CD) persists until the next delivery. We hypothesized that residual SHA may be present in a substantial proportion of women and is associated with increased post-operative pain. METHODS: One hundred and sixty-three women scheduled for a repeat CD under spinal anaesthesia were enrolled into the study. Mechanical temporal summation (mTS) and SHA index were measured preoperatively. SHA was considered present when the index was >0. Post-operative pain scores at 12, 24 and 48 h and wound hyperalgesia (WHA) at 48 h were recorded. RESULTS: SHA was present in 67 women 41% with a median SHA index of 0.42 (Q (25)  = 0.25; Q (75)  = 1.1, range 0.03-4.25). Women with SHA had overall higher post-operative pain scores and SHA was correlated with preoperative mTS (r = 0.164, p < 0.05), post-operative pain severity (r = 0.25, p < 0.002) and WHA at 48 h (r = 0.608, p < 0.001). Severe pain (visual analogue pain scale-S48 ≥ 7, n = 20) was predicted with a sensitivity and specificity of 60% and 62%, respectively. Positive predictive value was 18% and negative predictive value was 92%. CONCLUSIONS: Preoperative SHA is present in 41% of women scheduled for repeat CD and is associated with increased mTS and post-operative pain. Screening for preoperative SHA may predict women at risk for increased post-operative pain, and guide post-operative analgesia to include anti-hyperalgesic drugs.
    European journal of pain (London, England) 01/2013; 17(1). DOI:10.1002/j.1532-2149.2012.00171.x · 3.22 Impact Factor
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    • "Nevertheless, the most recently published study compares well with similar rates at 14.4% at 6 weeks (Crotty & Sheehan, 2004). Previous international researches have reported similar rates at 6 weeks (Gao, Chan, & Mao, 2008) and varying rates from 11.2% at 8 weeks (Eisenach et al., 2008) to 10.4% at 9 weeks (O' Hara, Zekoski, Phillips, & Wright, 1990) to 23.3% at 14 weeks (Stuart, Couser, Schilder, O'Hara, & Gorman, 1998) and 29.9% between 6 and 24 weeks (Ege, Timur, Zincir, Geçkil, & Sunar- Reeder, 2008). The variability could be due to differences in sample methodologies/demographics , data collection points, and method of measuring depressive symptoms. "
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    ABSTRACT: Postnatal depression (PND) is a significant public health issue, with variable prevalence and a dearth of research on risk and protective factors. This quantitative longitudinal study of 512 first-time mothers identified the prevalence of PND and examined the relationships between functional and structural social support at 6 and 12 weeks postpartum. The prevalence of PND was 13.2% at 6 weeks and 9.8% at 12 weeks. At 6 and 12 weeks, the only social support dimension independently associated with PND was total functional social support. At-birth formal structural support and emotional functional support were independently predictive of PND at 12 weeks.
    Archives of psychiatric nursing 06/2011; 25(3):174-84. DOI:10.1016/j.apnu.2010.08.005 · 1.03 Impact Factor
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