Persistent pain after cesarean delivery

Area of Science:

• Obstetrics and Gynecology
• Pain Medicine
• Surgical Outcomes Research

Background:

• Persistent pain after cesarean delivery (CD) impacts a significant number of women, despite a lower incidence compared to other surgeries.
• The rising CD rate amplifies the public health relevance of understanding and managing post-cesarean persistent pain.
• The unique peripartum state and oxytocin may offer protective effects against chronic pain development.

Purpose of the Study:

• To review the incidence and pathophysiology of persistent pain following cesarean delivery (CD).
• To explore risk factors, including acute postoperative pain severity and opioid exposure, associated with chronic pain after CD.
• To examine modifiable prevention strategies and tailored treatments for women at risk of persistent pain post-CD.

Main Methods:

• Narrative review of existing literature on persistent pain after cesarean delivery.
• Analysis of the transition from acute to chronic pain, emphasizing cesarean-specific factors.
• Evaluation of predictive tools and their clinical feasibility for identifying high-risk patients.

Main Results:

• While less common than after other surgeries, persistent pain after CD affects many women due to high annual delivery volumes.
• Acute postoperative pain severity and opioid exposure are linked to the development of persistent pain.
• Current predictive tools for high-risk pain patients show limited accuracy and clinical utility.

Conclusions:

• Modified surgical techniques, neuraxial anesthesia, and opioid-sparing analgesia are potential strategies to mitigate persistent pain after CD.
• Further research into the protective peripartum factors could yield novel approaches for chronic pain prevention.
• Identifying and managing modifiable risk factors is crucial for optimizing recovery and care quality for women undergoing cesarean delivery.