Chronic pain after childbirth

Landau, Ruth; Bollag, Laurent; Ortner, Clemens

doi:10.1016/j.ijoa.2013.01.008

Cited by 69 publications

(39 citation statements)

References 104 publications

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“…It is also important to note that the absolute increase in risk is very small. A recent prospective study found that chronic pain attributable to Cesarean delivery at one-year follow-up is rare, affecting less than 1% of patients,(28) although other studies have reported higher rates;(29) some of the persistent use that we observe may be for this indication. Data from other surgical procedures suggest that most patients with chronic pain following surgery discontinue opioids, and that persistent use is more often tied to affective distress than chronic pain;(17) establishing whether this applies to opioid use after Cesarean delivery will be an important direction for future research.…”

Section: Discussionmentioning

confidence: 51%

Persistent opioid use following cesarean delivery: patterns and predictors among opioid-naïve women

Bateman

Franklin

Bykov

et al. 2016

American Journal of Obstetrics and Gynecology

232

197

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Background The incidence of opioid-related death in women has increased five-fold over the past decade. For many women, their initial opioid exposure will occur in the setting of routine medical care. Approximately 1 in 3 deliveries in the U.S. is by Cesarean and opioids are commonly prescribed for post-surgical pain management. Objective The objective of this study was to determine the risk that opioid naïve women prescribed opioids after Cesarean delivery will subsequently become consistent prescription opioid users in the year following delivery, and to identify predictors for this behavior. Study Design We identified women in a database of commercial insurance beneficiaries who underwent Cesarean delivery and who were opioid-naïve in the year prior to delivery. To identify persistent users of opioids, we used trajectory models, which group together patients with similar patterns of medication filling during follow-up, based on patterns of opioid dispensing in the year following Cesarean delivery. We then constructed a multivariable logistic regression model to identify independent risk factors for membership in the persistent user group. Results 285 of 80,127 (0.36%, 95% confidence interval 0.32 to 0.40), opioid-naïve women became persistent opioid users (identified using trajectory models based on monthly patterns of opioid dispensing) following Cesarean delivery. Demographics and baseline comorbidity predicted such use with moderate discrimination (c statistic = 0.73). Significant predictors included a history of cocaine abuse (risk 7.41%; adjusted odds ratio 6.11, 95% confidence interval 1.03 to 36.31) and other illicit substance abuse (2.36%; adjusted odds ratio 2.78, 95% confidence interval 1.12 to 6.91), tobacco use (1.45%; adjusted odds ratio 3.04, 95% confidence interval 2.03 to 4.55), back pain (0.69%; adjusted odds ratio 1.74, 95% confidence interval 1.33 to 2.29), migraines (0.91%; adjusted odds ratio 2.14, 95% confidence interval 1.58 to 2.90), antidepressant use (1.34%; adjusted odds ratio 3.19, 95% confidence interval 2.41 to 4.23) and benzodiazepine use (1.99%; adjusted odds ratio 3.72, 95% confidence interval 2.64 to 5.26) in the year prior to Cesarean delivery. Conclusions A very small proportion of opioid-naïve women (approximately 1 in 300) become persistent prescription opioid users following Cesarean delivery. Pre-existing psychiatric comorbidity, certain pain conditions, and substance use/abuse conditions identifiable at the time of initial opioid prescribing were predictors of persistent use.

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Section: Discussionmentioning

confidence: 51%

Persistent opioid use following cesarean delivery: patterns and predictors among opioid-naïve women

Bateman

Franklin

Bykov

et al. 2016

American Journal of Obstetrics and Gynecology

232

197

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“…For labor, neuraxial analgesia provides superior pain relief to other analgesic modalities and decreases circulating catecholamine levels, which may be particularly beneficial for patients with hypertensive disorders of pregnancy or preexisting comorbidities. Likewise, for cesarean delivery, neuraxial anesthesia has many maternal [287][288][289][290][291][292][293][294][295][296][297][298][299] and fetal 298-302 benefits compared with general anesthesia, including decreased risk of pulmonary complications awareness under anesthesia and surgical infections, as well as enabling immediate postdelivery mother-infant bonding (Table 18).…”

Section: Neuraxial and General Anesthesia In The Obstetric Patientmentioning

confidence: 99%

“…Decreases anesthesia-related adverse events (eg, pulmonary or cardiac complications, cardiac arrest) 287 Reduces risk of gastric aspiration [288][289][290] Avoids hypertensive response to intubation in vulnerable population (eg, preeclampsia) 290 Avoids awareness under general anesthesia 291 Reduces risk of intraoperative uterine atony and hemorrhage [292][293][294] Reduces surgical site infection 295 Provides superior quality with systemic opioid-sparing cesarean analgesia; reduces risk of chronic postdelivery pain 296,297 Enables benefits of immediate postdelivery skin-to-skin bonding and breastfeeding 298,299 Improves maternal and paternal participation in birth 299 …”

Section: Maternal Benefitsmentioning

confidence: 99%

Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy

Horlocker

Vandermeuelen

Kopp

et al. 2018

Regional Anesthesia and Pain Medicine

616

104

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“…Further supporting altered visceral afferent processing, it was observed that visceral pain, but not incisional and referred pain, during the first week after laparoscopic cholecystectomy is associated with chronic unexplained pain of more than 12 months duration (Blichfeldt-Eckhardt et al 2014). Finally, neuropathic pain associated with the incisional scar, as well as visceral pain traits reflected by presence of deep abdominal and pelvic pain (often related to uterine contractions), have been suggested to develop and even coexist in patients undergoing obstetric interventions (Landau et al 2013; Lavand’homme 2013). Interestingly, afferent transmission modulation by epidural analgesia (Bouman et al 2014) or sacral nerve stimulation (Martellucci et al 2012) efficiently reduces the incidence of chronic postsurgical pain, including deep pain.…”

Section: Discussionmentioning

confidence: 99%

Axotomy of tributaries of the pelvic and pudendal nerves induces changes in the neurochemistry of mouse dorsal root ganglion neurons and the spinal cord

et al. 2015

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Using immunohistochemical techniques, we characterized changes in the expression of several neurochemical markers in lumbar 4-sacral 2 (L4-S2) dorsal root ganglion (DRG) neuron profiles (NPs) and the spinal cord of BALB/c mice after axotomy of the L6 and S1 spinal nerves, major tributaries of the pelvic (targeting pelvic visceral organs) and pudendal (targeting perineum and genitalia) nerves. Sham animals were included. Expression of cyclic AMP-dependent transcription factor 3 (ATF3), calcitonin gene-related peptide (CGRP), transient receptor potential cation channel subfamily V, member 1 (TRPV1), tyrosine hydroxylase (TH) and vesicular glutamate transporters (VGLUT) types 1 and −2 was analysed seven days after injury. L6-S1 axotomy induced dramatic de novo expression of ATF3 in many L6-S1 DRG NPs, and parallel significant downregulations in the percentage of CGRP-, TRPV1-, TH- and VGLUT2-immunoreactive (IR) DRG NPs, as compared to their expression in uninjured DRGs (contralateral L6-S1-AXO; sham mice); VGLUT1 expression remained unaltered. Sham L6-S1 DRGs only showed a small ipsilateral increase in ATF3-IR NPs (other markers were unchanged). L6-S1-AXO induced de novo expression of ATF3 in several lumbosacral spinal cord motoneurons and parasympathetic preganglionic neurons; in sham mice the effect was limited to a few motoneurons. Finally, a moderate decrease in CGRP- and TRPV1-like-immunoreactivities was observed in the ipsilateral superficial dorsal horn neuropil. In conclusion, injury of a mixed visceral/non-visceral nerve leads to considerable neurochemical alterations in DRGs matched, to some extent, in the spinal cord. Changes in these and potentially other nociception-related molecules could contribute to pain due to injury of nerves in the abdominopelvic cavity.

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Chronic pain after childbirth

Cited by 69 publications

References 104 publications

Persistent opioid use following cesarean delivery: patterns and predictors among opioid-naïve women

Persistent opioid use following cesarean delivery: patterns and predictors among opioid-naïve women

Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy

Axotomy of tributaries of the pelvic and pudendal nerves induces changes in the neurochemistry of mouse dorsal root ganglion neurons and the spinal cord

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