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Postpartum Pain Type, Especially Affective Dimensions of Pain, Predict Increased Opioid Requirements
Abstract Number: O1-04
Abstract Type: Original Research
Pain is a multidimensional construct comprising sensory, cognitive, and affective dimensions. We assessed relationships between acute postpartum pain type, pain intensity and opioid dose. We hypothesized that affective dimensions of pain associated with postpartum opioid dose.
A retrospective, mixed-methods design was used to analyze quantitative and qualitative pain responses from postpartum women during hospitalization. Patient-reported pain descriptors were coded using established pain terms from SF-MPQ and PROMIS inventories. Based on these terms, codes were produced for the following pain types: affective/evaluative, visceral/nociceptive, somatic/nociceptive, dynamic/evoked, neuropathic, nociceptive, nociceptive and/or neuropathic. Pain intensity scores (0-10 numeric rating scale) were given with each pain descriptor. Multivariable linear mixed-effects model analyses assessed between- and within-person relationships for: 1) pain type (primary predictor) and pain intensity (0-10); and 2) pain type (primary predictor) and oxycodone dose (mg). The influence of opioid dependence history (OUD) on these relationships was assessed by interaction terms.
2,609 women provided 44,522 unique pain scores/descriptors during their postpartum hospital stay. Opioid dose requirement was 1.04 mg (P<0.001) higher for women with affective pain compared to women without affective pain, after controlling for age, gravidity, parity, and mode of delivery. Similarly, but to a lesser extent (lower coefficients), other pain types were associated with increased opioid dose (Table 1). Postpartum pain intensity was nonspecific and associated with multiple different pain types (Table 2). A history of OUD increased the relationship between pain type, pain intensity, and opioid dose. For a woman with OUD, times when she had affective pain resulted in pain scores 0.93 points higher; between OUD women, expected pain scores were 6.24 points higher for women with affective pain. Similarly, for a woman with OUD, times when she had nociceptive and/or neuropathic pain resulted in oxycodone doses 1.56 mg higher; between OUD women, expected oxycodone dose was 11.38 mg higher for women with this pain type.
Pain type is linked to postpartum opioid dose requirements; affective dimensions of pain show the highest contributions to this relationship. Pain intensity scores (0-10) are inadequate to comprehensively assess the postpartum acute pain experience, particularly for important outcomes such as opioid use.