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

Abstract

Objectives To investigate the overall incidence and risk factors for persistent pain and its interference with daily life after cesarean section. Design Prospective long-term follow-up study. Setting Karolinska University Hospital, Stockholm, Sweden. Population 260 healthy women who underwent elective cesarean section. Methods Information on demographics, medical history, postoperative pain and analgesic requirements was collected. A questionnaire consisting of the Brief Pain Inventory was posted at 3, 6 and 12 months after surgery. Women rated pain intensity as well as interference with factors related to general function and quality of life. Main outcome measures The overall incidence and risk factors for persistent postoperative pain at three time points. Persistent pain was considered a secondary outcome. Results At 3, 6 and 12 months respectively 40, 27 and 22% of patients reported pain in one or more locations, in the surgical site as well as in other areas. A psychological indication, as well as a first cesarean section, increased the risk for pain at 3 months. Severe postoperative pain in the immediate postoperative period or undergoing a first cesarean section were significant independent risk factors for the development of persistent pain up to 6 months after cesarean section. Parameters related to quality of life were significantly impaired in women with persistent pain. Conclusion Several factors, including severe postoperative pain, were shown to influence the risk for persistent pain after cesarean section. Long-term pain markedly affected women's wellbeing.