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Quantitative Sensory Testing to Predict Labor Pain and Postpartum Depression
Abstract Number: O1-03
Abstract Type: Original Research
Intro. Emerging data suggests that perinatal pain and postpartum depression (PPD) symptoms are linked to one another. Little is known about predictors for the experience of labor pain, and by what mechanisms it relates to postpartum depression. We assessed quantitative sensory testing (QST) as a predictor of both perinatal pain and PPD symptoms.
Methods. Women were followed from the prenatal period through labor and delivery until six weeks and three months postpartum. Prenatal (third trimester) QST was performed for heat and mechanical temporal summation, heat and pressure threshold, and heat and pressure tolerance. Electronic labor pain data was collected hourly in real time, capturing pain unpleasantness and intensity on a 100mm line. Prenatal and postpartum data included anxiety and depressive symptoms, perceived social support, pain catastrophizing, and the Brief Pain Inventory (BPI). The primary outcome was Edinburgh Postnatal Depression Score (EPDS) at six weeks as a marker of PPD symptoms. Labor pain outcomes of interest were labor pain intensity area under the curve (AUC), pain unpleasantness AUC, pain intensity max, and pain unpleasantness max. Single and multivariable linear regressions examined QST measures as predictors of both EPDS and labor pain.
Results. 164 completed QST testing. Of these, 73 had 6-week EPDS, and 52 had complete labor pain diaries and received epidural analgesia. After adjusting for covariates (baseline: anxiety, body mass index (BMI), pain catastrophizing, EPDS, race), the six-week EPDS was significantly associated with heat temporal summation (tTS), and the three-month EPDS scores were significantly associated with mechanical temporal summation (mTS, probe weight). In adjusted analyses, mTS and heat threshold were significantly predictive for baseline EPDS. For labor pain outcomes, after adjusting for BMI, pain catastrophizing, race, last known cervical exam at the time of labor epidural analgesia request, and duration of labor, no labor pain outcomes were significantly related to any QST measures.
Conclusions. QST measures, specifically mTS and tTS, may be useful for predicting EPDS in the prenatal, 6-week postpartum, and 3-month postpartum periods. Prenatal QST appears inadequate for predicting perinatal pain. These findings point to potential unique and distinct pathways for perinatal pain and PPD, although potential common mechanisms by pain inhibition/CPM plasticity need to be evaluated.