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Patterns of recovery from pain after cesarean delivery

Booth, Jessica L.a; Sharpe, Emily E.b; Houle, Timothy T.c; Harris, Lynnettea; Curry, Regina S.a; Aschenbrenner, Carol A.a; Eisenach, James C.a,*

doi: 10.1097/j.pain.0000000000001313
Research Paper

We know very little about the change in pain in the first 2 months after surgery. To address this gap, we studied 530 women scheduled for elective cesarean delivery who completed daily pain diaries for 2 months after surgery through text messaging. Over 82% of subjects missed fewer than 10 diary entries and were included in the analysis. Completers were more likely to be Caucasian, nonsmokers, and with fewer previous pregnancies than noncompleters. Daily worst pain intensity ratings for the previous 24 hours were fit to a log(time) function and allowed to change to a different function up to 3 times according to a Bayesian criterion. All women had at least one change point, occurring 22 ± 9 days postoperatively, and 81% of women had only one change, most commonly to a linear function at 0 pain. Approximately 9% of women were predicted to have pain 2 months after surgery, similar to previous observations. Cluster analysis revealed 6 trajectories of recovery from pain. Predictors of cluster membership included severity of acute pain, perceived stress, surgical factors, and smoking status. These data demonstrate feasibility but considerable challenges to this approach to data acquisition. The form of the initial process of recovery from pain is common to all women, with divergence of patterns at 2 to 4 weeks after cesarean delivery. The change-point model accurately predicts recovery from pain; its parameters can be used to assess predictors of speed of recovery; and it may be useful for future observational, forecasting, and interventional trials.

Daily pain intensity after cesarean delivery declines in a log(time) manner followed by a change at 2 to 4 weeks to a linear or quadratic form.

aDepartment of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, United States

bDepartment of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN, United States

cDepartment of Anesthesiology and Perioperative Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States

Corresponding author. Address: Department of Anesthesiology, Wake Forest School of Medicine, Medical Center Blvd, Winston Salem, NC 27157-1009, United States. Tel.: (336)-716-4182; fax: (336) 716-0288. E-mail address: (J.C. Eisenach).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Received March 03, 2018

Received in revised form June 01, 2018

Accepted June 05, 2018

© 2018 International Association for the Study of Pain
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