Highlights
- •391 patients scheduled for elective caesarean section underwent a 6-month follow-up.
- •A high preoperative mental quality-of-life generally protected from persistent pain.
- •Other risk factors were inconstantly identified, depending on the aspect of persistent pain.
- •The caesarean section model is less influenced by psychological factors, than hysterectomy.
Abstract
This French multicenter prospective cohort study recruited 391 patients to investigate
the risk factors for persistent pain after elective cesarean delivery, focusing on
psychosocial aspects adjusted for other known medical factors. Perioperative data
were collected and specialized questionnaires were completed to assess reports of
pain at the site of surgery. Three dependent outcomes were considered: pain at the
third month after surgery (M3, n = 268; risk = 28%), pain at the sixth month after
surgery (M6, n = 239; risk = 19%), and the cumulative incidence (up to M6) of neuropathic
pain, as assessed using the Douleur Neuropathique 4 questionnaire (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 a peripheral neuropathic event, and preoperative anxiety.
Trial Registration
ClinicalTrials.gov, NCT00812734.
Perspective
Persistent pain after cesarean delivery has a relatively frequent neuropathic aspect
but this is less stable than that after other surgeries. When comparing the risk factor
analyses with published data for hysterectomy, the influence of preoperative psychological
factors seems less important, possibly because of the different context and environment.
Key words
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Article info
Publication history
Published online: August 20, 2015
Accepted:
August 5,
2015
Received in revised form:
July 7,
2015
Received:
April 1,
2015
Footnotes
This study was funded by the French Program for Hospital Clinical Research (Programme Hospitalier de Recherche Clinique, appel d'offre national 2005) and Pfizer. Christian Dualé, as the coordinating investigator, had support from Pfizer for the conduct of the study, by subsidies paid to the University Hospital of Clermont-Ferrand, and for giving a presentation including the results of the study and discussing neuropathic postsurgical persistent pain at the EFIC Congress in Hamburg, Germany (September 2011). None of the other authors had relationships with any company that might have an interest in the submitted work in the previous 3 years.
Supplementary data accompanying this article are available online at www.jpain.org and www.sciencedirect.com.
Identification
Copyright
© 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.
