The incidence of chronic pain following Cesarean section and associated risk factors: A cohort of women followed up for three months

Abstract

Background Chronic post-surgical pain (CPSP) is one of the post-surgical complications of a Cesarean section. Despite the high rates of Cesarean section worldwide, the incidence of CPSP and the risk factors for this condition remain relatively unknown. The objective of this study was to calculate the incidence of CPSP in women submitted to Cesarean section and to analyze the associated risk factors. Materials and methods A prospective cohort of 621 women undergoing Cesarean section was recruited preoperatively. Potential presurgical (sociodemographic, clinical and lifestyle-related characteristics) and post-surgical risk factors (the presence and intensity of pain) risk factors were analyzed. Pain was measured at 24 hours and 7, 30, 60 and 90 days after surgery. Following discharge from hospital, data were collected by telephone. The outcome measure was selfreported pain three months after a Cesarean section. The risk factors for chronic pain were analyzed using the log-binomial regression model (a generalized linear model). Results A total of 462 women were successfully contacted 90 days following surgery. The incidence of CPSP was 25.5% (95%CI: 21.8-29.7). Risk factors included presurgical anxiety (adjusted relative risk [RR] 1.03; 95%CI: 1.01-1.05), smoking (adjusted RR 2.22; 95%CI: 1.27-3.88) and severe pain in the early postoperative period (adjusted RR 2.79; 95%CI: 1.29-6.00).

Current Challenges in the Management of Chronic Pelvic Pain in Women: From Bench to Bedside

“…Trait anxiety has already been associated with chronic pain following Cesarean section. 82 Despite the limitations involved in determining the order in which the manifestations begin and in establishing a cause-effect relationship, the prognosis of patients with CPP is guarded when these aspects are not taken into consideration in conjunction. 79 , 83 , 84 …”

Dolor crónico poscesárea, un problema desconocido

“…Hay varios estudios internacionales que estudian el dolor crónico poscesárea, los más recientes de China [12] y Brasil [13]. En este último se pesquisó 25,5% de dolor crónico poscesárea a los tres meses, con 47,5% de las pacientes catalogado como moderado y 36,4% como intenso.…”

Efficacy And Safety of Wound Infiltration Modalities For Postoperative Pain Management After Cesarean Section: A Systematic Review, Meta-Analysis, And Trial Sequential Analysis Protocol

“…Despite the advancement in the understanding of pathophysiology of postoperative pain introduction of different postoperative analgesic drugs and modalities, the prevalence of postoperative pain after cesarean section is persistently high which ranges from 25.5 to 80% due to individual variability and limitation from side effects of analgesic drugs or techniques employed (8,23,24,27, 28,30,31).…”

“…A number of postoperative pain management techniques were practiced over the years after cesarean section but they were associated with postoperative adverse events to the mother (9-15). The most commonly practiced postoperative pain management techniques include but not limited to systemic opioid and non-opioid drugs, regional blocks and local wound in ltration of different local anesthetics and other drugs(9-22).Evidences showed that individual variability of pain is greatly in uenced by sensitivity to pain gender, age, genetics, preoperative anxiety, preoperative pain, history of depressive symptoms, and history of substance use (8,(23)(24)(25)(26)(27)(28)(29).Despite the advancement in the understanding of pathophysiology of postoperative pain introduction of different postoperative analgesic drugs and modalities, the prevalence of postoperative pain after cesarean section is persistently high which ranges from 25.5 to 80% due to individual variability and limitation from side effects of analgesic drugs or techniques employed (8,23,24,27, 28,30,31).The postoperative pain after cesarean section negatively affects ambulation, breastfeeding and maternal bonding(32). Besides, Inadequately managed acute postoperative pain is associated with different effects related to physiological and psychological implications which includes, postpartum depression, myocardial infarction, pulmonary infection, reduced gastric motility, nausea, vomiting oliguria, decreased immune function, and wound healing (23, 28,29).…”