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Recovery of physical activity after cesarean delivery and its relationship with pain

Sharpe, Emily E.a; Booth, Jessica L.b; Houle, Timothy T.c; Pan, Peter H.d; Harris, Lynnette C.d; Aschenbrenner, Carol A.d; Eisenach, James C.d,*

doi: 10.1097/j.pain.0000000000001628
Research Paper

Pain and physical activity are tightly intertwined. Although their relationship has been explored in chronic pain conditions, we know little about the pattern of recovery in activity and its short- and long-term relationship with pain after surgery. We recruited 103 women undergoing elective cesarean delivery and acquired daily pain assessments and hourly steps in 98 of them for 2 months after surgery. Compliance was good, with 78% of subjects missing less than 7 days of activity. Study personnel required daily checking for compliance and 20 minutes per subject per week in study. Activity increased over the first 2 postoperative months in a log(time) manner. The slope of each modeled individual curve for activity was inversely correlated (r = −0.54; P < 0.0001) with worst daily pain. After removing these 2-month trends, pain and activity within an individual day were negatively associated with each point increase in pain being inversely associated with −119 steps (95% confidence interval [CI] = −214 to −25; P = 0.013). A patient's previous experience of pain was not associated with current activity as well as current activity was not associated with future pain scores. These data, although limited by the study of a single operation in a unique social circumstance with low risk of chronic postsurgical pain, demonstrate feasibility of measuring hourly activity for 2 months after surgery. Recovery from pain and inactivity are tightly correlated, and the negative relationship between within-day pain and activity without interday carryover relationships is in stark contrast to findings in chronic pain conditions.

Daily steps after cesarean delivery increases in a log(time) manner with a slope that is inversely correlated with worst daily pain.

aDepartment of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States

bDepartment of Anesthesiology, University of Colorado Health in Colorado Springs, Colorado Springs, CO, United States

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

dDepartment of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, 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.

© 2019 International Association for the Study of Pain
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