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Characterising long term pain after caesarean section: a prospective, longitudinal study
Abstract Number: F-12
Abstract Type: Original Research
Aim: It is thought that up to 18% of cesarean section patients may experience chronic post-surgical pain (CPSP) lasting >3 months. The Oxford Persisting Post-Operative Pain Study (OxPPOPS) is an on-going prospective, longitudinal study (the largest in the UK to date) assessing the incidence and predictive factors of pain up to 1 year after planned cesarean section. Predictive factors such as patient psychology, pain perception, surgical and anesthetic techniques, and acute post-operative pain management are under investigation.
Methods: Following ethics board approval, 670 women aged 18-45 undergoing planned cesarean section at a gestation >34 weeks have been recruited into the study. Exclusion criteria include pre-pregnancy painful conditions and depression. Follow-up data are presented here from 119 women at 4 and 12 months after surgery, collected using postal questionnaires. Women were asked to report whether or not they were suffering from pain related to their cesarean section. The intensity of the pain experienced at rest and on movement was rated on a numerical rating scale (NRS) of 0-10. The women also answered questions about pain frequency and analgesia use. NRS rating comparisons were performed using Wilcoxon signed-rank tests.
Results: Four months after surgery, 25% of women (n=30) reported suffering from pain related to their cesarean section. This was most commonly experienced on a weekly basis (50%, n=15). By 12 months pain had resolved in approximately half of the women with only 13% (n=16) reporting suffering from pain, most commonly on a monthly basis (44%, n=7). Two women reported pain at 12 months although they had no pain at 4 months. In women who were experiencing pain at 4 months, median (IQR) NRS of pain at rest was 0(0) and on movement was 1(1). At 12 months, median NRS was 0(1) and median NRS on movement was 2(3). At both time points, NRS on movement was significantly higher than at rest (Wilcoxon,p<0.001 at 4 months and p<0.002 at 12 months). Approximately 3% of women (n=3 at 4 months, n=4 at 12 months) reported taking mild analgesics as required in the preceding week. One woman reported regular codeine use at 4 months only.
Discussion: One year after planned cesarean section, women report suffering from pain at an incidence of 14%, which is within the range of previous studies. Frequency of pain occurrence and pain intensity ratings decreased between 4 and 12 months. These pain outcomes will be further analyzed along with predictive factors, with the goal of identifying patients at increased risk of developing CPSP.
1. Kainu JP, Sarvela J, Tippana E, Halmesmaki E, & Korttila KT. (2010). Persistent pain after caesarean section and vaginal birth. Int J Obstet Anesth, 19: 4-9.