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Emotional Burden and Psychophysical Predictors of Labor Pain
Abstract Number: F4B-1
Abstract Type: Original Research
Intro. Labor analgesia is associated with reduced risk for postpartum depression (1,2,3), but the nature of this relationship is poorly understood. Understanding the relationship is key to identifying the role that targeted analgesic interventions may have in women predisposed to pain-associated depression. As a first step to better understanding this relationship, we aimed to characterize the physical and emotional components of labor pain, and to identify psychophysical predictors of labor pain.
Methods. After written informed consent, pregnant women in their third trimester, with singleton gestation, and planning to use labor epidural analgesia were recruited and prospectively followed. At the third trimester clinic visit, psychometric assessment by quantitative sensory testing (QST) measurements, encompassing heat threshold and tolerance, pressure threshold and tolerance, and heat and mechanical temporal summation, were recorded. Baseline anxiety, pain catastrophizing, and resiliency were measured. During labor and delivery, women completed hourly assessments of pain intensity and pain unpleasantness by visual analog scale on 100-millimeter lines using an electronic pain diary. Pearson coefficient estimated the correlation between pain intensity and pain unpleasantness. The relationship between QST variables and pain burden will be assessed by simple and multiple linear regression, in which baseline and demographic variables will be controlled.
Results. 56 women completed all study procedures. Pain intensity and pain unpleasantness are highly correlated, indicating similar emotional and physical pain burdens during labor (Pearson correlation coefficient estimate, 0.97). Pain intensity and unpleasantness exhibit high inter- and intra-individual variability (Figure). Heat and mechanical temporal summation are significant predictors of pain intensity burden (data to be presented).
Conclusions. The physical and emotional components of pain are highly correlated in laboring women. Heat and mechanical temporal summation predict labor pain intensity, with mechanical temporal summation being easily performed at the bedside. Psychophysical predictors of labor pain will classify women susceptible to severe labor pain, enabling targeted enrollment for future investigations.
1. Anesth Analg.2014;119:383-92
2. Anesth Analg.2017 Dec 11
3. Pain. 2008;140:87-94