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Neuropathic features of chronic pain after caesarean section

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Neuropathic features of chronic pain after caesarean section


MH Lee, A Koelewyn, R Russell, O Kciuk, L Buck, NJ Beale, J Quinlan, CE Warnaby

Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK 

 

Introduction

Both nociceptive and neuropathic components are known to contribute to chronic post-surgical pain (CPSP)1.

•  The Oxford Persisting Post-Operative Pain Study (OxPPOPS) has found the incidence of CPSP after elective caesarean section (CS) to be 22% and 9% at 4 and 12 months, respectively.

•  We investigated whether the CPSP experienced by these women had any neuropathic features using painDETECT, a questionnaire-based neuropathic screening tool2.

 

Methods

•After ethical approval and informed consent, 728 women were included in the study.

•Post-operative questionnaire data were available from 411 women at 4 months and 298 women at 12 months at the time of analysis.

 

painDETECT questionnaire (PD-Q)

•PD-Q data were analyzed for the women who reported suffering from CS-related CPSP.

•  This equated to n=85 and n=28 women at 4 months at 12 months, respectively.

•  The PD-Q was used to characterise the intensity and location of pain, as well as the severity of any sensory abnormalities and neuropathic pain features in these women.

•  Women rated their pain intensity ‘now at this moment’ and their strongest and average pain in the last 4 weeks using a 0-10 numerical rating scale (NRS).

•  The total painDETECT score reflects the likelihood of neuropathic features in pain.


Results

Postoperative CS-related pain intensities


Post-operative pain location

Women with CS-related pain most often report abdominal pain at both time-points (Table 1).

 

Neuropathic features of CPSP after elective CS

CS-related numbness and pressure sensitivity most common at both time-points (Fig. 2).

•At 4 months, women with abdominal pain only (n=50) mostly report numbness (90%) (Fig. 3).

Those with both abdominal and back pain (n=16) all had sensitivity to pressure (100%).

 

•  3 women (4%) at 4 months and 1 (4%) woman at 12 months have likely neuropathic pain (Fig. 4).

•  11 women and 5 women in the unclear category at 4 and 12 months, respectively.

•  One woman maintained likely neuropathic pain from 4 to 12 months.

 

Conclusion

•Our data suggest CPSP after elective CS is unlikely to be neuropathic in nature.

CS-related pain with neuropathic features is experienced by <5% of women at 4 months, equivalent to <1% of study population.


Acknowledgements

Funding was provided by OAA and the NIHR Clinical Research Network. We would also like to thank the John Radcliffe Women’s Centre staff for their support of the study.


References

1.Kehlet H, Jensen TS, Woolf CJ. Lancet 2006;367:1618-25. 

2.Freynhagen R, et al. Curr Med Res Opin 2006;22:1911-20. 


Summary

•  We investigated whether the chronic post-surgical pain (CPSP) after elective CS had neuropathic features.

•  Using painDETECT, a neuropathic screening tool, we collected data on the nature, location and intensity of pain.

•  Pain was most commonly located in the abdomen and back.

•  Numbness and pressure sensitivity were the most prevalent sensory abnormalities reported.

•  Neuropathic CPSP was experienced by <5% of women 4 months after CS, which equated to <1% of the study population. 

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