The association of pain and psychological vulnerabilities with postpartum pain catastrophizing: a secondary analysis of a randomized controlled trial.

IF 3.3 3区医学 Q1 ANESTHESIOLOGY Canadian Journal of Anesthesia-Journal Canadien D Anesthesie Pub Date : 2025-04-01 Epub Date: 2025-03-20 DOI:10.1007/s12630-025-02920-8

Joel Chee Yee Chan, Rehena Sultana, Deepak Mathur, Chin Wen Tan, Ban Leong Sng

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Abstract

Purpose: Pain catastrophizing is an amplified negative thought process that emerges during actual or perceived pain moments. There is limited information on the role of labour pain in the development of pain catastrophizing during the postpartum period. We sought to investigate whether labour pain, pain, and psychological vulnerabilities are associated with high pain catastrophizing (defined as a Pain Catastrophizing Scale [PCS] ≥ 25) at 6-10 weeks postpartum.

Methods: We conducted a secondary analysis of a randomized controlled trial that recruited pregnant individuals at term prior to labour and delivery. Participants filled in the predelivery questionnaires on labour pain, pain, and psychological vulnerabilities upon written consent. The recruited parturients also completed an online survey 6-10 weeks postpartum to determine the status of pain catastrophizing.

Results: Among the 820 parturients who completed the postpartum online survey, 116 (14.4%) were high pain catastrophizing. Multivariate logistic regression analysis found that greater enormity of labour pain (adjusted odds ratio [aOR], 1.04; 95% confidence interval [CI], 1.02 to 1.06), choosing nonepidural over epidural analgesia (aOR, 1.84; 95% CI, 1.17 to 2.91), having a family history of other mental disorders (aOR, 31.3; 95% CI, 5.7 to 173.7), greater predelivery pain catastrophizing (aOR, 2.70; 95% CI, 1.68 to 4.36), greater predelivery activity avoidance (aOR, 1.06; 95% CI, 1.04 to 1.09), and greater predelivery state anxiety (aOR, 1.03; 95% CI, 1.01 to 1.05) were associated with postpartum pain catastrophizing at 6-10 weeks postpartum. Having greater infant weight was protective against the risk of postpartum pain catastrophizing (aOR, 0.43; 95% CI, 0.23 to 0.78). The area under the curve of the generated multivariable model was 0.82 (95% CI, 0.78 to 0.86).

Conclusion: Predelivery pain and psychological vulnerabilities were associated with postpartum pain catastrophizing among healthy parturients undergoing labour. Future prospective studies are needed to evaluate whether such risk factors can allow earlier intervention to reduce pain catastrophizing.

Study registration: ClinicalTrials.gov ( NCT03167905 ); first submitted 30 May 2017.

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疼痛和心理脆弱性与产后疼痛灾难化的关联：随机对照试验的二次分析。

目的：痛苦灾难化是一种放大的消极思维过程，出现在实际或感知的痛苦时刻。有有限的信息的作用，分娩疼痛在发展的疼痛灾难在产后时期。我们试图调查分娩疼痛、疼痛和心理脆弱性是否与产后6-10周的高疼痛灾难化（定义为疼痛灾难化量表[PCS]≥25）有关。方法：我们对一项随机对照试验进行了二次分析，该试验招募了分娩前足月的孕妇。经书面同意，参与者填写分娩前疼痛、疼痛和心理脆弱性问卷。招募的产妇还在产后6-10周完成了一项在线调查，以确定疼痛灾难化的状态。结果：在820例完成产后在线调查的产妇中，有116例（14.4%）存在高疼痛灾难化。多因素logistic回归分析发现分娩疼痛更严重(调整优势比[aOR]， 1.04；95%可信区间[CI]， 1.02 ~ 1.06)，选择非硬膜外镇痛优于硬膜外镇痛(aOR, 1.84；95% CI, 1.17 - 2.91)，有其他精神障碍家族史(aOR, 31.3；95% CI, 5.7 ~ 173.7)，更大的产前疼痛灾难化(aOR, 2.70；95% CI, 1.68 - 4.36)，更多的产前活动避免(aOR, 1.06；95% CI, 1.04 ~ 1.09)，以及更大的产前状态焦虑(aOR, 1.03；95% CI, 1.01 ~ 1.05)与产后6-10周的产后疼痛严重化相关。较大的婴儿体重对产后疼痛灾难化的风险有保护作用(aOR, 0.43；95% CI, 0.23 ~ 0.78)。生成的多变量模型曲线下面积为0.82 （95% CI, 0.78 ~ 0.86）。结论：分娩前疼痛和心理脆弱性与健康产妇产后疼痛灾难化相关。未来的前瞻性研究需要评估这些风险因素是否可以允许早期干预以减少疼痛灾难。研究注册：ClinicalTrials.gov (NCT03167905)；首次提交于2017年5月30日。

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来源期刊

Canadian Journal of Anesthesia-Journal Canadien D Anesthesie 医学-麻醉学

CiteScore

8.50

自引率

7.10%

发文量

161

审稿时长

6-12 weeks

期刊介绍： The Canadian Journal of Anesthesia (the Journal) is owned by the Canadian Anesthesiologists’ Society and is published by Springer Science + Business Media, LLM (New York). From the first year of publication in 1954, the international exposure of the Journal has broadened considerably, with articles now received from over 50 countries. The Journal is published monthly, and has an impact Factor (mean journal citation frequency) of 2.127 (in 2012). Article types consist of invited editorials, reports of original investigations (clinical and basic sciences articles), case reports/case series, review articles, systematic reviews, accredited continuing professional development (CPD) modules, and Letters to the Editor. The editorial content, according to the mission statement, spans the fields of anesthesia, acute and chronic pain, perioperative medicine and critical care. In addition, the Journal publishes practice guidelines and standards articles relevant to clinicians. Articles are published either in English or in French, according to the language of submission.