Risk factors for persistent pain and its influence on maternal wellbeing after cesarean section

Acta Obstet Gynecol Scand. 2015 Jun;94(6):622-8. doi: 10.1111/aogs.12613. Epub 2015 Mar 19.


Objectives: To investigate the overall incidence and risk factors for persistent pain and its interference with daily life after cesarean section.

Design: Prospective long-term follow-up study.

Setting: Karolinska University Hospital, Stockholm, Sweden.

Population: 260 healthy women who underwent elective cesarean section.

Methods: Information on demographics, medical history, postoperative pain and analgesic requirements was collected. A questionnaire consisting of the Brief Pain Inventory was posted at 3, 6 and 12 months after surgery. Women rated pain intensity as well as interference with factors related to general function and quality of life.

Main outcome measures: The overall incidence and risk factors for persistent postoperative pain at three time points. Persistent pain was considered a secondary outcome.

Results: At 3, 6 and 12 months respectively 40, 27 and 22% of patients reported pain in one or more locations, in the surgical site as well as in other areas. A psychological indication, as well as a first cesarean section, increased the risk for pain at 3 months. Severe postoperative pain in the immediate postoperative period or undergoing a first cesarean section were significant independent risk factors for the development of persistent pain up to 6 months after cesarean section. Parameters related to quality of life were significantly impaired in women with persistent pain.

Conclusion: Several factors, including severe postoperative pain, were shown to influence the risk for persistent pain after cesarean section. Long-term pain markedly affected women's wellbeing.

Keywords: Cesarean section; persistent pain; postoperative pain; quality of life; risk factors.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cesarean Section*
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Longitudinal Studies
  • Pain Measurement
  • Pain, Postoperative / epidemiology*
  • Pain, Postoperative / psychology*
  • Pregnancy
  • Prospective Studies
  • Quality of Life
  • Risk Factors
  • Surveys and Questionnaires
  • Sweden / epidemiology