title: Prospective longitudinal cohort questionnaire assessment of labouring women's preference both pre- and post-delivery for either reduced pain intensity for a longer duration or greater pain intensity for a shorter duration.
abstract: BACKGROUND
  Assessments of labour pain focus on pain intensity, not on duration. We aimed to assess the importance labouring women apply to pain intensity and duration before labour and post-delivery.
  
  
  METHODS
  Forty healthy women scheduled for labour induction were enrolled in this institutional review board-approved, prospective cohort study. Participants completed a pain preference questionnaire before active labour and within 24-h of delivery. The questionnaire consisted of seven stem questions that evaluated preference for pain intensity or duration. The pain preference ratio was determined by dividing the percentage of women who preferred reduced pain intensity for longer duration by that of those who preferred greater pain intensity for shorter duration (estimate of the odds). The overall hypothetical pain burden was determined by multiplying intensity by time. All questions presented the same overall hypothetical pain burden.
  
  
  RESULTS
  Pain preference questionnaire scores demonstrated preference for low intensity pain for a longer duration rather than higher intensity for a shorter duration, both pre-labour (P<0.001) and post-delivery (P<0.001): the null median imputed as 3 of 6 (i.e. no preference for pain intensity over pain duration). This preference for pain duration over intensity was greater post-delivery compared with before labour (P=0.03). There was a significant correlation (r=0.83; P=0.04) between the pain preference ratio vs overall hypothetical pain burden before labour but not after delivery (r=0.28; P=0.59).
  
  
  CONCLUSIONS
  In this preliminary labour assessment, women preferred lower pain intensity at the cost of longer pain duration. This suggests that pain intensity is the primary driver of hypothetical pain burden-a preference reinforced post-delivery.
authors.affiliation: Department of Anesthesia, Stanford University School of Medicine, H3580, Stanford, CA 94305, USA bcarvalho@stanford.edu.
authors.forename: B
authors.initials: B
authors.lastname: Carvalho
authors.affiliation: Department of Anesthesia, Stanford University School of Medicine, H3580, Stanford, CA 94305, USA.
authors.forename: G
authors.initials: G
authors.lastname: Hilton
authors.affiliation: Department of Anesthesia, Stanford University School of Medicine, H3580, Stanford, CA 94305, USA.
authors.forename: L
authors.initials: L
authors.lastname: Wen
authors.affiliation: Department of Anesthesia, Stanford University School of Medicine, H3580, Stanford, CA 94305, USA Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Ein Kerem, PO Box 12000, Jerusalem, Israel.
authors.forename: C F
authors.initials: CF
authors.lastname: Weiniger
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods / Q000523:psychology; D016362:Analgesia, Obstetrical / Q000379:methods / Q000523:psychology*; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000523:psychology*; D005260:Female; D006801:Humans; D048949:Labor Pain / Q000523:psychology*; D007743:Labor, Obstetric / Q000523:psychology*; D008137:Longitudinal Studies; D057240:Patient Preference / Q000523:psychology* / Q000706:statistics & numerical data*; D011159:Population Surveillance; D011247:Pregnancy; D011446:Prospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult
keywords: analgesia; labour pain; pain; patient preference