title: Incidence and severity of chronic pain after caesarean section: A systematic review with meta-analysis.
abstract: BACKGROUND
  The frequency of caesarean section has increased dramatically in recent decades. Despite this, robust data regarding the consequences of caesarean section in terms of developing chronic postsurgical pain (CPSP) are still lacking.
  
  
  OBJECTIVE
  This systematic review analysed the incidence and severity of CPSP in women 3 to less than 6, 6 to less than 12, and at least 12 months after caesarean section.
  
  
  METHODS
  Systematic review of prospective and retrospective observational studies and randomised controlled trials with meta-analysis.
  
  
  METHODS
  We searched MEDLINE to May 2015.
  
  
  METHODS
  We included all studies investigating the incidence and/or severity of CPSP at least 3 months after caesarean section. The primary outcome was chronic postsurgical wound pain (CPSP 'wound'). Secondary outcomes were persistent pain in the back area, pelvic region or reported as residual pain, and severity of 'birth-related' chronic pain.
  
  
  RESULTS
  Meta-analysis using the random-effects model based on 15 studies (n = 4475) reporting CPSP 'wound' at 3 to less than 6 months after caesarean section revealed an incidence of 15.4% [95% confidence interval (CI): 9.9 to 20.9%]. For 6 to less than 12 and at least 12 months after caesarean section, the incidence of CPSP 'wound' was estimated at 11.5% (95% CI: 8.1 to 15.0%, n = 3345) and 11.2% (95% CI: 7.4 to 15.0%, n = 3451), respectively. Meta-regression analysis using the publication year as predictor revealed stable CPSP 'wound' incidences at each postoperative time slot from 2002 to the present. Of those patients who reported chronic pain, 9.6% (95% CI: 0.0 to 21.0%) had severe pain, 23.5% (95% CI: 10.0 to 37.0%) had moderate pain and 49.2% (95% CI: 18.9 to 79.4%) had mild pain at 6 months.
  
  
  CONCLUSIONS
  Major limitations are high statistical heterogeneity of the meta-analyses and inconsistencies in reporting severity of chronic 'birth-related' pain.
  
  
  CONCLUSIONS
  This meta-analysis finds a clinically relevant incidence of CPSP 'wound' after caesarean section ranging from 15% at 3 months to 11% at 12 months or longer that has been largely stable in recent years.
authors.affiliation: aFrom the Department of Anaesthesia and Critical Care, University Hospital of Wuerzburg, Wuerzburg (SW, KN, YJ, NR, PK), Department of Anaesthesiology and Intensive Care, Jena University Hospital, Jena (WM) and Department of Obstetrics and Gynaecology, University Hospital of Wuerzburg, Wuerzburg, Germany (AW) *Stephanie Weibel and Katharina Neubert contributed equally to the writing of this article.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Weibel
authors.forename: Katharina
authors.initials: K
authors.lastname: Neubert
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Jelting
authors.forename: Winfried
authors.initials: W
authors.lastname: Meissner
authors.forename: Achim
authors.initials: A
authors.lastname: Wöckel
authors.forename: Norbert
authors.initials: N
authors.lastname: Roewer
authors.forename: Peter
authors.initials: P
authors.lastname: Kranke
mesh_terms: D002585:Cesarean Section / Q000009:adverse effects* / Q000639:trends; D059350:Chronic Pain / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D064887:Observational Studies as Topic / Q000379:methods; D010149:Postoperative Pain / Q000175:diagnosis / Q000453:epidemiology; D011247:Pregnancy; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index; D000072836:Surgical Wound / Q000175:diagnosis / Q000453:epidemiology