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A Prospective Observational Study Evaluating the Ability of Prelabor Psychological Tests to Predict Labor Pain, Epidural Analgesic Consumption, and Maternal Satisfaction

Carvalho, Brendan MBBCh, FRCA*; Zheng, Ming PhD*; Aiono-Le Tagaloa, Leinani MBChB, FANZCA

doi: 10.1213/ANE.0000000000000357
Obstetric Anesthesiology: Research Report

BACKGROUND: Psychological characteristics may affect interpretation and expression of pain. In this study, we sought to determine whether validated psychological tests predict the labor pain experience.

METHODS: Thirty-nine women with singleton term or post-term pregnancies undergoing induction of labor and successful vaginal delivery comprised the study population for this prospective observational study. Four validated psychological questionnaires (Anxiety Sensitivity Index [ASI], Fear of Pain [FPQIII], Pain Catastrophizing Scale [PCS]), and Eysenck Personality Questionnaire–Short Scale) and 3-scaled ratings of anxiety, confidence, and analgesic expectations were completed before onset of labor. Outcome measures included time to epidural analgesia request, pain at request for epidural analgesia, area under the pain × time curve (AUC), epidural local anesthetic use per hour, and maternal satisfaction with analgesia. The relationship between psychological predictors and clinical responses was assessed using bivariate correlations and regression modeling.

RESULTS: Labor pain AUC (R 2 = 0.45, P = 0.006), epidural local anesthetic use (R 2 = 0.45, P = 0.019), and time to epidural analgesia request (R 2 = 0.36, P = 0.015) were predicted with models incorporating some of the prelabor predictors. ASI, PCS, personality traits (lying, extroversion, psychoticism), and scaled ratings of anxiety, confidence, and analgesic expectations all contributed to the regression models of the outcomes. After proper model selection, neither FPQIII nor PCS was in the final multivariate linear regression model for labor pain AUC, although ASI was still included (P = 0.022). There was no significant correlation between ASI and self-reported anxiety (r = 0.03, P = 0.91).

CONCLUSIONS: Personality traits (psychoticism, extroversion, and lying), as well as scaled ratings of anxiety, confidence, and analgesia expectations, show some potential to predict labor pain, epidural local anesthetic use, and time to epidural analgesia request. Although ASI was included in the final model for labor pain AUC, and FPQ and PCS were not, further study is required to determine whether ASI is a better predictor than FPQ or PCS.

Published ahead of print July 15, 2014.

From the *Department of Anesthesia, Stanford University School of Medicine, Stanford, California; and †Department of Anaesthesia and Pain, Auckland Hospital, Auckland, New Zealand.

Published ahead of print July 15, 2014.

Accepted for publication May 27, 2014.

Funding: None.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Brendan Carvalho, MBBCh, FRCA, Department of Anesthesia, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305. Address e-mail to bcarvalho@stanford.edu.

© 2014 International Anesthesia Research Society