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

University of Geneva, Genève, Geneva, Switzerland
Pain (Impact Factor: 5.21). 10/2008; 140(1):87-94. DOI: 10.1016/j.pain.2008.07.011
Source: PubMed


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.

    • "Although caesarean delivery and operative vaginal delivery have been associated with higher levels of acute pain compared to unassisted vaginal delivery [10], the mode of delivery has not been consistently linked to persistent pain_ENREF_6 [1] [5] [8] [10] [20] [29]._ENREF_5_ENREF_5 Indicators of tissue trauma, such as episiotomy or perineal tears, does not seem to influence recovery after childbirth;[9]_ENREF_5 however, high acute pain intensity in connection with childbirth has been consistently associated with persistent pelvic pain [10]. "
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    ABSTRACT: In this longitudinal population study, the aims were to study associations of mode of delivery with new onset of pelvic pain and changes in pelvic pain scores up to 7-18 months after childbirth. We included 20,248 participants enrolled in the Norwegian Mother and Child Cohort Study (1999-2008) without preexisting pelvic pain in pregnancy. Data were obtained by four self-administered questionnaires and linked to the Medical Birth Registry of Norway. A total of 4.5% of the women reported new onset of pelvic pain 0-3 months postpartum. Compared to unassisted vaginal delivery, operative vaginal delivery was associated with increased odds of pelvic pain (adjusted odds ratio 1.30; 95% confidence interval: 1.06-1.59). Planned and emergency cesarean deliveries were associated with reduced odds of pelvic pain (adjusted odds ratio 0.48; 95% confidence interval: 0.31-0.74 and adjusted odds ratio 0.65; 95% confidence interval: 0.49-0.87, respectively). Planned cesarean delivery, young maternal age, and low Symptom Checklist-8 scores were associated with low pelvic pain scores after childbirth. A history of pain was the only factor associated with increased pelvic pain scores over time (P=0.047). We conclude that new onset of pelvic pain after childbirth was not commonly reported, particularly following cesarean delivery. Overall, pelvic pain scores were rather low at all time points and women with a history of pain reported increased pelvic pain scores over time. Hence, clinicians should follow up women with pelvic pain after a difficult childbirth experience, particularly if they have a history of pain.
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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.
    Full-text · Article · Dec 2014 · European journal of pain (London, England)
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    • "In addition, maternal hyperventilation in response to labor pain causes adverse effects such as reduced fetal oxygen delivery [1,2]. Besides these acute maternal and fetal hemodynamic and metabolic responses, intense labor pain has been correlated with the development of postpartum posttraumatic stress [3], postpartum depression, and persistent pain [4]. "
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    ABSTRACT: Labor pain is one of the most challenging experiences encountered by females during their lives. Neuraxial analgesia is the mainstay analgesic for intrapartum pain relief. However, despite the increasing use and undeniable advantages of neuraxial analgesia for labor, there have been concerns regarding undesirable effects on the progression of labor and outcomes. Recent evidence indicates that neuraxial analgesia does not increase the rate of Cesarean sections, although it may be associated with a prolonged second stage of labor and an increased rate of instrumental vaginal delivery. Even when neuraxial analgesia is administered early in the course of labor, it is not associated with an increased rate of Cesarean section or instrumental vaginal delivery, nor does it prolong the labor duration. These data may help physicians correct misconceptions regarding the adverse effects of neuraxial analgesia on labor outcome, as well as encourage the administration of neuraxial analgesia in response to requests for pain relief.
    Full-text · Article · Nov 2013 · Korean journal of anesthesiology
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