title: Persistent pain after caesarean section and its association with maternal anxiety and socioeconomic background.
abstract: BACKGROUND
  Pain, both from the surgical site, and from other sources such as musculoskeletal backache, can persist after caesarean section. In this study of a predominantly socially deprived population we have sought to prospectively examine the association between antenatal maternal anxiety and socioeconomic background and the development of persistent pain of all sources after caesarean section.
  
  
  METHODS
  Demographic details and an anxiety questionnaire were completed by 205 women before elective caesarean section. On the first postoperative day, pain scores were recorded, and at four months patients were asked to complete a Brief Pain Inventory and an Edinburgh Postnatal Depression Score.
  
  
  RESULTS
  Of 205 parturients recruited, 186 records were complete at the hospital admission phase and 98 (52.7%) were complete at the four-month follow-up phase. At recruitment, 15.1% reported pain. At four months 41.8% (95% CI 32.1 to 51.6%) reported pain, of whom pain was a new finding in 35.7% (95% CI 26.2 to 45.2%). Antenatal anxiety was not a significant predictor of severity of new pain at four months (P=0.44 for state anxiety, P=0.52 for trait anxiety). However, four-month pain severity did correlate with social deprivation (P=0.011), postnatal depression (P<0.001) and pain at 24h (P=0.018).
  
  
  CONCLUSIONS
  Persistent pain from a variety of sources after caesarean section is common. Our findings do not support the use of antenatal anxiety scoring to predict persistent pain in this setting, but suggest that persistent pain is influenced by acute pain, postnatal depression and socioeconomic deprivation.
authors.affiliation: Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, Scotland, UK.
authors.forename: B
authors.initials: B
authors.lastname: Daly
authors.affiliation: Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, Scotland, UK. Electronic address: steven.young@ggc.scot.nhs.uk.
authors.forename: S
authors.initials: S
authors.lastname: Young
authors.affiliation: Academic Department of Anaesthesia, The New Lister Building, University of Glasgow, Glasgow, Scotland, UK.
authors.forename: R
authors.initials: R
authors.lastname: Marla
authors.affiliation: Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, Scotland, UK.
authors.forename: L
authors.initials: L
authors.lastname: Riddell
authors.affiliation: Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, Scotland, UK.
authors.forename: R
authors.initials: R
authors.lastname: Junkin
authors.affiliation: Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, Scotland, UK.
authors.forename: N
authors.initials: N
authors.lastname: Weidenhammer
authors.affiliation: Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, Scotland, UK.
authors.forename: J
authors.initials: J
authors.lastname: Dolan
authors.affiliation: Academic Department of Anaesthesia, The New Lister Building, University of Glasgow, Glasgow, Scotland, UK.
authors.forename: J
authors.initials: J
authors.lastname: Kinsella
authors.affiliation: Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland, UK.
authors.forename: R
authors.initials: R
authors.lastname: Zhang
mesh_terms: D000328:Adult; D001007:Anxiety / Q000150:complications* / Q000523:psychology*; D002585:Cesarean Section; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D009035:Mothers / Q000523:psychology*; D010149:Postoperative Pain / Q000150:complications* / Q000503:physiopathology / Q000523:psychology*; D011446:Prospective Studies; D012959:Socioeconomic Factors
keywords: Anxiety; Caesarean section; Chronic; Pain; Persistent; Postnatal depression; Socioeconomic deprivation