Incidence and Associated Factors of Chronic Pain After Caesarean Section: A Systematic Review

The number of Caesarean section (CS) procedures has increased dramatically both in developed and developing countries in recent decades. CS has been associated with chronic pain. A vicious impediment on quality of life may occur among women who experience chronic post-CS pain (CPCSP). Therefore, this systematic review aimed to synthesize the available evidence on the incidence of chronic pain after Caesarean delivery and the possible risk factors for the development of chronic pain. The PubMed, Embase, and Google Scholar databases were searched for articles published in English between 2004 and January 2017 using appropriate terms. Studies that examined the incidence of chronic pain after CS as their primary outcome measure, and follow-up period of more than 2 months was selected. Both authors searched and reviewed the studies for eligibility and extracted the data in predefined forms. We also conducted a hand search of the reference lists of included articles. Findings from the reviewed studies are summarized using narrative and tables. Of the 4932 records, 17 studies met the review eligibility criteria. This review found that the incidence of CPCSP varies among studies and is influenced by preoperative patient factors and surgical- and anaesthetic-related factors. Of the reviewed studies, the majority were examined for chronic pain at 3 months after CS. The incidence of CPCSP after 2 to less than 6 months was found to range between 4% and 41.8%. The reported factors that influence CPCSP were inconsistent among studies. Despite this, the presence of a higher intensity of pain on postoperative day 1 was the most commonly identified factor associated with CPCSP. This systematic review found a clinically important incidence of CPCSP, ranging from 4% to 41.8% at 2 to less than 6 months after CS. Moreover, the evidence demonstrates that severe acute postoperative pain after CS is an important contributing factor for the development of CPCSP. However, no strong evidence-based conclusions and recommendations may be drawn from the evidence. Future well-designed studies with a longer follow-up period are needed to identify the most important perioperative factors associated with chronic pain following Caesarean delivery.