François Mirault’s scientific contributions

This French multicentric prospective cohort study recruited 391 patients to investigate the risk factors for persistent pain after elective caesarean section, focusing on psychosocial aspects as adjusted to other known medical factors. Perioperative data was collected and specialised questionnaires were completed to assess the report of pain at the site of surgery. Three dependent outcomes were considered: pain at the 3(rd) month after surgery (M3, n = 268; risk = 28%), pain at the 6(th) month after surgery (M6, n = 239; risk =19%), and the cumulative incidence (up to M6) of neuropathic pain, as assessed using the DN4 (n = 218; risk = 24.5%). The neuropathic aspect of reported pain changed over time in more than 60% of cases, pain being more intense if associated with neuropathic features. Whatever the dependent outcome, a high mental component of quality-of-life (SF-36) was protective. Pain at M3 was also predicted by pain reported during current pregnancy and a history of miscarriage. Pain at M6 was also predicted by report of a postoperative complication. Incident neuropathic pain was predicted by pain reported during current pregnancy, a previous history of peripheral neuropathic event, and preoperative anxiety. ClinicalTrials.gov, NCT00812734. Persistent pain after caesarean section displays a relatively frequent neuropathic aspect but this is less stable than that following other surgeries. Also, when comparing the risk factor analyses to published data for hysterectomy, the influence of preoperative psychological factors seems less important, possibly because of the different context and environment. Copyright © 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.