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Chronic Pain in the Obstetric population: A Systematic Review.
Abstract Number: S 13
Abstract Type: Original Research
INTRODUCTION: The occurrence of chronic pain in the obstetric population is well documented. About 32% of the approximately 4,000,000 annual births in the United States are by cesarean delivery. 1 Prevalence of rates of chronic pain after delivery varies widely among studies. This systematic review evaluates the incidence of chronic pain in the obstetric population.
METHODS: The authors searched MEDLINE; Embase; Cochrane Database of Systematic Reviews; Cochrane Central Register of Controlled Trials; The search terms Delivery, Obstetric, Labor, Obstetric, Pregnancy, Chronic Pain, Pain measurement, were used in combination with the medical subject headings pregnancy/ pregnant/ obstetric labour/ obstetric labor/ delivery/ obstetric delivery/ vaginal deliver/ cesarean deliver/ cesarean section/ chronic pain/ pain scale/ pain measurement/ pain assessment. Studies that reported the incidence of chronic pain at 2 to 12 months after delivery were included.
RESULTS: Twenty-two studies including 7 RCTs and 15 cohort studies evaluating a total of 12,126 patients were identified (N= 4987 vaginal delivery; N=7139 cesarean delivery). The incidence of pain reported at 2-3 months varied between 4 and 79% (Figure 1). By 6 and 12 months the incidence of reported pain had reduced to between 1-18% and 0.3-12% respectively.
DISCUSSION: Our study was conducted to systematically review the literature and evaluate the incidence of chronic pain in the obstetric population. We have found that there is a wide range of incidence of chronic pain ranging between 1-79%. 2-4 Several factors could contribute to this heterogeneity: lack of standardization to evaluate chronic pain; racial and ethnic differences among populations studied, low response rate to questionnaires and recall bias impact on retrospective designs. A recently published study by Eisenach et al.5 showed a very low rate of incidence (1.8% at 6 months and 0.3% at 12 months), suggesting that chronic pain as a result of vaginal or cesarean delivery tends to resolve with time. Additional systematic, prospective trials need to be conducted to further investigate the incidence of chronic pain in the obstetric population.
Figure 1. CS = cesarean section; *pain reported at 6 weeks
1) http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_01.pdf#table02 2) Pain 2008 140(1):87-94 3) JAMA 2002 287(14):1822-31 4) Birth 2008 35(1):16-24 5) Anesthesiology 2013 118(1):143-51.