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Defining the Friedman curve for post-cesarean delivery pain
Abstract Number: BP-06
Abstract Type: Original Research
Introduction: Although much is known about pain experience in the first few days after surgery and at other isolated times accessing the health care system, usually once a few weeks and months after surgery, the pattern of recovery over the first several weeks is not well described. This is akin to knowing the time between the average cervical dilatation on admission to labor and delivery and the time of complete cervical dilatation, without any knowledge of the expected patterns of dilatation over time. Just as these patterns in labor are important, so too may they be in predicting and managing pain after surgery.
Methods: After IRB approval, 575 ASA I-III parturients presenting for elective cesarean delivery (C/D) were enrolled from April 2013-November 2015. Demographics, medical and OB history, and neonatal outcomes were collected. Patients completed validated preoperative questionnaires on perceived stress, emotional distress, and a three question pain prediction survey previously validated at our institution(1). On POD1, patients answered 4 questions assessing average and worst pain using a VAS sliding scale (0-100). From POD2 to POD60, patients answered 6 questions on current, worst, and average pain intensity and unpleasantness (0-10) by daily email or text message. Latent class analysis of the worst daily pain intensity scores from POD2 through POD28 was performed.
Results: Analysis of 530 evaluable patients identified 3 subgroups of pain recovery (see Figure). The model with the best fit showed two groups with linear trajectories (58% and 32%) and one group (10%) with a quadratic trajectory of pain recovery after C/D. While 58% of women have no pain by POD25, 10% of women report a pain score >5 on POD28. The distributions of scores on the perceived stress scale and emotional distress survey were significantly different among all 3 groups (p<.01) and correlate with postoperative pain scores.
Conclusions: The use of daily pain scores, rather than infrequent sampling, shows large variability in recovery pattern from pain after elective C/D and that these patterns segregate into 3 trajectories. This approach and these data could in the future be used by patients and clinicians to gauge recovery from pain in real time and by researchers to better identify risk factors for slow recovery and test whether interventions speed recovery in all patients or only in subgroups.
1. Pan PH, et al. Anesthesiology 2013;118(5);1170-1179.
Supported by R37 GM48085