Abstract
Introduction Preexisting chronic pain has been reported to be a consistent risk factor for severe acute postoperative pain. However, each specific chronic pain condition has unique pathophysiology, and it is possible that the effect of each condition on postoperative pain is different. Methods This is a retrospective cohort study of pregnant women with preexisting chronic pain conditions (i.e., migraine, chronic back pain, and the combination of migraine + chronic back pain), who underwent cesarean delivery. The effects of the three chronic pain conditions on time-weighted average (TWA) pain score (primary outcome) and opioid dose requirements in morphine milligram equivalents (MME) during postoperative 48 hours were compared. Results The TWA pain score was similar in preexisting migraine and chronic back pain. Chronic back pain was associated with significantly greater opioid dose requirements than migraine (12.92 MME, 95% CI: 0.41 to 25.43, P=0.041). Preoperative opioid use (P < 0.001) was associated with a greater TWA pain score. Preoperative opioid use (P < 0.001), smoking (P=0.004), and lower postoperative ibuprofen dose (P=0.002) were associated with greater opioid dose requirements. Conclusions Findings suggest women with chronic back pain and migraine do not report different postpartum pain intensities; however, women with preexisting chronic back pain required 13 MME greater opioid dose than those with migraine during 48 hours after cesarean delivery.
Highlights
Preexisting chronic pain has been reported to be a consistent risk factor for severe acute postoperative pain
Chronic back pain alone was associated with significantly greater opioid dose requirements than migraine alone (12.92 milligram equivalents (MME), 95% CI: 0.41 to 25.43, P 0.041). e combination of both conditions was associated with greater opioid dose requirement than migraine alone (10.39 MME, 95% CI: −15.47 to 36.24, P > 1) and slightly less than chronic back pain alone (2.53 MME, 95% CI: −28.40 to 33.47, P > 1), but neither difference was statistically significant
We found no significant differences in postoperative pain intensity during 48 postoperative hours with any of the chronic pain conditions that were compared
Summary
Preexisting chronic pain has been reported to be a consistent risk factor for severe acute postoperative pain. Findings suggest women with chronic back pain and migraine do not report different postpartum pain intensities; women with preexisting chronic back pain required 13 MME greater opioid dose than those with migraine during 48 hours after cesarean delivery. Severe acute postpartum pain is a strong risk factor for chronic postcesarean pain, [1, 2], and estimated 1 in 300 opioid-naıve women becomes persistent opioid users after cesarean delivery [3]. Along with female sex [6, 7] and younger age [6,7,8,9], preexisting chronic pain has been reported to be the most consistent risk factor for severe acute postoperative pain [6, 9,10,11,12]. Each chronic pain condition has unique pathophysiology and symptomatology, and it is possible that the effect of each condition on postoperative pain is different
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