Chronic Pain after Caesarean Delivery: An Australian Cohort

Abstract

We investigated the incidence of and risk factors for persistent pain after caesarean delivery. Over a 12-month period, women having caesarean delivery were recruited prospectively at an Australian tertiary referral centre. Demographic, anaesthetic and surgical data were collected and at 24 hour follow-up, women were assessed for immediate postoperative pain and preoperative expectations of pain. Long-term telephone follow-up was conducted at two and 12 months postoperatively. Complete data were obtained from 426 of 469 women initially recruited (90.6%). The incidence of persistent pain at the abdominal wound at two months was 14.6% (n=62) but subsequently reduced to 4.2% (n=18) at 12 months. At two months, 33 patients (7.8%) experienced constant or daily pain. At 12 months, five patients (1.1%) continued to have constant or daily pain which was mild. There was no apparent increase in incidence of persistent pain associated with general versus regional anaesthesia (relative risk [RR] 0.89, 95% confidence interval [CI] 0.49 to 1.6); emergency vs elective procedure (RR 0.65, 95% CI 0.39 to 1.07); higher acute pain scores (RR 1.1, 95% CI 0.69 to 1.75); or history of previous caesarean delivery (RR 0.81, 95% CI 0.50 to 1.33). Persistent pain, usually of a mild nature, is reported by some women two months after their caesarean delivery, but by 12 months less than 1% of women had pain requiring analgesia or affecting mood or sleep. All declined a pain clinic review. Clinicians and patients can be reassured that caesarean delivery is unlikely to lead to severe persistent pain in the long-term.

Risk factors for persistent pain and its influence on maternal wellbeing after cesarean section

“…Our data show that abdominal pain was present in 5.6% of women responding to the questionnaire at 12 months. Similar findings were reported by Liu and coworkers, who found an incidence of 4.2% at the same time point .…”

The Short-FormMcGill Pain Questionnaire-Revised to Evaluate Persistent Pain and Surgery-Related Symptoms in Healthy Women Undergoing a Planned Cesarean Delivery

“…Importantly, we found a lower incidence of chronic pain than that reported by others with study designs that were fundamentally different. 8 Initial investigations reporting higher incidences of chronic pain were all retrospective mail surveys, [3][4][5][6] with all the limitations of such methodology. In other studies, a variety of factors, such as undergoing a general anesthetic, emergency or second repeat CD, closure of the peritoneum, or a history of significant chronic pain, have been found to be associated with persistent pain.…”

“…This is an exploratory study from an observational trial with ongoing data collection that was designed based on the assumption that 10% of women following a planned CD will develop chronic pain. However, given recent findings, 7,8 which showed significantly lower than expected incidence of chronic pain after delivery, we decided to evaluate the incidence in our cohort and potentially adjust our sample size. Our findings indicate that our originally defined sample size is sufficient to predict persistent pain at 8 weeks and that chronic post-CD pain is extremely low, but that surgery-related symptoms were present in a high proportion of women (22%).…”

“…7,8 Two recent large, prospective cohort studies, focusing on new onset of pain, reported low incidences of chronic pain 0.3% postpartum 7 and 4% post-CD 8 at 12 months. Limitations of these studies were a high dropout rate, 7 no imputation for lost data, 8 and no characterization of persistent pain.…”

“…7,8 Two recent large, prospective cohort studies, focusing on new onset of pain, reported low incidences of chronic pain 0.3% postpartum 7 and 4% post-CD 8 at 12 months. Limitations of these studies were a high dropout rate, 7 no imputation for lost data, 8 and no characterization of persistent pain. 7,8 Because neuropathic pain is one of the essential characteristics of persistent post-Pfannenstiel incision pain, 5 a detailed description of pain characteristics is paramount to our understanding of persistent pain after CD.…”