title: The Role of Psychological Factors in Persistent Pain After Cesarean Delivery.
abstract: This French multicenter prospective cohort study recruited 391 patients to investigate the risk factors for persistent pain after elective cesarean delivery, focusing on psychosocial aspects adjusted for other known medical factors. Perioperative data were collected and specialized questionnaires were completed to assess reports of pain at the site of surgery. Three dependent outcomes were considered: pain at the third month after surgery (M3, n = 268; risk = 28%), pain at the sixth month after surgery (M6, n = 239; risk = 19%), and the cumulative incidence (up to M6) of neuropathic pain, as assessed using the Douleur Neuropathique 4 questionnaire (n = 218; risk = 24.5%). The neuropathic aspect of reported pain changed over time in more than 60% of cases, pain being more intense if associated with neuropathic features. Whatever the dependent outcome, a high mental component of quality of life (SF-36) was protective. Pain at M3 was also predicted by pain reported during current pregnancy and a history of miscarriage. Pain at M6 was also predicted by report of a postoperative complication. Incident neuropathic pain was predicted by pain reported during current pregnancy, a previous history of a peripheral neuropathic event, and preoperative anxiety.
  
  
  BACKGROUND
  ClinicalTrials.gov, NCT00812734.
  
  
  CONCLUSIONS
  Persistent pain after cesarean delivery has a relatively frequent neuropathic aspect but this is less stable than that after other surgeries. When comparing the risk factor analyses with published data for hysterectomy, the influence of preoperative psychological factors seems less important, possibly because of the different context and environment.
authors: CHU Bordeaux, Département d'Anesthésie-Réanimation 1, Hôpital Pellegrin, Bordeaux, France.
authors: Brice
authors: B
authors: Richez
authors: CHU Clermont-Ferrand, Pôle Santé Publique, Clermont-Ferrand, France; Univ Clermont1, Clermont-Ferrand, France; CNRS, ISIT, UMR6284, BP10448, Clermont-Ferrand, France.
authors: Lemlih
authors: L
authors: Ouchchane
authors: CHU Clermont-Ferrand, Pôle Santé Publique, Clermont-Ferrand, France; Univ Clermont1, Clermont-Ferrand, France; CNRS, ISIT, UMR6284, BP10448, Clermont-Ferrand, France.
authors: Aline
authors: A
authors: Guttmann
authors: Clinique de la Chataîgneraie, Anesthésie-Réanimation, Beaumont, France.
authors: François
authors: F
authors: Mirault
authors: CHU Clermont-Ferrand, Pôle Anesthésie-Réanimation-Estaing, Gynécologie-Obstétrique-Reproduction humaine, Clermont-Ferrand, France.
authors: Martine
authors: M
authors: Bonnin
authors: CHU Strasbourg, Anesthésiologie, Hôpital de Hautepierre, Strasbourg, France.
authors: Yves
authors: Y
authors: Noudem
authors: CHU Lyon (HCL), Anesthésie-Réanimation, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France.
authors: Virginie
authors: V
authors: Cognet
authors: CHU Lille, Anesthésie-Réanimation, Hôpital Jeanne-de-Flandre, Lille, France.
authors: Anne-Frédérique
authors: AF
authors: Dalmas
authors: CHG Roanne, Anesthésie-Réanimation, Roanne, France.
authors: Lise
authors: L
authors: Brisebrat
authors: CHU Clermont-Ferrand, Centre de Pharmacologie Clinique, Clermont-Ferrand, France.
authors: Nicolas
authors: N
authors: Andant
authors: CHU Clermont-Ferrand, Centre de Pharmacologie Clinique, Clermont-Ferrand, France.
authors: Sylvie
authors: S
authors: Soule-Sonneville
authors: Univ Clermont1, Clermont-Ferrand, France; CHU Clermont-Ferrand, Centre de Pharmacologie Clinique, Clermont-Ferrand, France; Inserm, CIC1405 & U1107 "Neuro-Dol", Clermont-Ferrand, France.
authors: Claude
authors: C
authors: Dubray
authors: CHU Clermont-Ferrand, Centre de Pharmacologie Clinique, Clermont-Ferrand, France; Inserm, CIC1405 & U1107 "Neuro-Dol", Clermont-Ferrand, France. Electronic address: cduale@chu-clermontferrand.fr.
authors: Christian
authors: C
authors: Dualé
authors: Univ Clermont1, Clermont-Ferrand, France; CHU Clermont-Ferrand, Centre de Pharmacologie Clinique, Clermont-Ferrand, France; CHU Clermont-Ferrand, Pôle Anesthésie-Réanimation, Hôpital Gabriel-Montpied, Clermont-Ferrand, France.
authors: Pierre
authors: P
authors: Schoeffler
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology; D002585:Cesarean Section / Q000009:adverse effects* / Q000523:psychology*; D059350:Chronic Pain / Q000453:epidemiology / Q000209:etiology / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D009437:Neuralgia / Q000453:epidemiology / Q000523:psychology*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology / Q000523:psychology*; D011247:Pregnancy; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D013997:Time Factors
keywords: Douleur Neuropathique 4; Neuropathic pain; cesarean delivery; chronic pain; postsurgical pain