Subjective Versus Objective Pain Assessment in the Postpartum Period: Improving Pain Control After Vaginal Delivery [ID: 1378006]

Abstract

INTRODUCTION: The numerical pain rating scale (NPRS) is a validated measure to quantify acute pain; however, its utility after vaginal delivery is unclear. Poorly controlled postpartum pain can increase rates of complications; therefore, pain control is paramount. We investigated how subjective pain relates to objective pain in the postpartum period. METHODS: A prospective, observational study at a single academic hospital included patients with vaginal deliveries February to October 2021. Women with opioid use disorder, wound complication, hysterectomy, or readmission were excluded. Subjective pain assessment and NPRS were completed 2 weeks postdischarge. Subjective pain was recorded as “well controlled” versus “poorly controlled.” The numerical pain rating scale was scored 0–10. RESULTS: Two hundred thirty-eight patients were included, and 174 (73%) followed up. One hundred twenty (69%) reported “well-controlled” pain, and 54 (31%) reported “poorly controlled.” There was no significant difference in delivery mode, laceration, or nonopioid medication use (P>.05). Patients who used oxycodone were significantly more likely to report “poorly controlled” pain (P=.02). “Poorly controlled” pain was associated with higher median NPRS score (5 [interquartile range (IQR) 4–6] versus 2 [IQR 0–3], P<.001). Among patients with “poorly controlled” pain, 11 (20.4%) had NPRS scores of 0–3. Of those who reported “well-controlled” pain, 22 (18.3%) had NPRS scores of 4–10. CONCLUSION: While NPRS scores were higher for patients with “poorly controlled” pain, this was not universal. It is critical to accurately respond to postpartum pain for the nearly 20% of patients whose subjective experience did not correlate with their objective score. Titrating pain control to subjective and objective goals may improve patient experience and outcomes.