Associations of pain, analgesia technique, and psychological factors with central sensitization after childbirth

Central sensitization may contribute to persistent postpartum pain, but the factors associated with the pain outcome are poorly understood. We identified independent associated factors with elevated CSI scores at 6-10 weeks postpartum.

Pregnant women admitted for delivery were asked to complete pre-delivery questionnaires evaluating pain and psychological vulnerabilities. Data on labor pain intensity, obstetric interventions, and neonatal outcomes were collected. An online survey was conducted at 6-10 weeks postpartum to assess elevated CSI scores, defined a priori as a Central Sensitization Inventory (CSI) score of ≥50.

Of the 816 women, 401 (49.1%) had elevated CSI scores at 6-10 weeks postpartum. Multivariable analysis identified six independent associated factors of elevated CSI scores: Pre-delivery factors including higher Edinburgh Postnatal Depression Scale (EPDS) score (adjusted odds ratio (aOR) 1.42, 95%CI 1.15-1.74, p = 0.001); a higher pre-delivery CSI score (aOR 2.50, 95%CI 2.01-3.10, p < 0.0001); higher Angle Labor Pain Questionnaire (A-LPQ) Enormity of pain subscale score (aOR 1.24, 95%CI 1.05-1.47, p = 0.01), and higher Fear-Avoidance Components Scale (FACS) pain-related anxiety subscale score (aOR 1.26, 95%CI 1.04-1.51, p = 0.02); and obstetric complications including manual removal of the placenta (aOR 4.06, 95%CI 1.11-14.82, p = 0.03) and intrauterine growth restriction (aOR 8.90, 95%CI 1.12-70.74, p = 0.04) (AUC: 0.79 (95%CI 0.76-0.82)).

Increased pre-delivery pain and psychological vulnerabilities, and obstetric complications were independently associated with the development of elevated postpartum CSI scores. Recognition of these associated factors may help identify women at risk and inform targeted strategies to mitigate central sensitization and persistent pain.

Clinicaltrials.govNCT03167905.