Pre-operative pain and psychological vulnerability factors associated with primary cesarean delivery: An observational study

Background: Primary cesarean delivery increases the risk of persistent pain. It is unclear whether maternal pain and psychological vulnerability factors associated with persistent pain are present in parturients undergoing primary cesarean delivery, which may provide insights into the etiology underlying the increased risk of persistent pain development in these parturients. We aimed to identify pre-operative pain and psychological vulnerability factors such as pain catastrophizing (primary association variable), depressive symptoms, central sensitization, anxiety, anticipated pain intensity, and anticipated analgesic requirement associated with primary cesarean delivery (primary outcome measure). Materials and Methods: This was a secondary analysis of a prospective cohort study investigating factors associated with maternal emesis following cesarean delivery. A questionnaire assessing pain catastrophizing, central sensitization, anxiety, and depressive symptoms, was administered pre-operatively. Univariate and multivariable analyzes were performed to identify factors associated with primary cesarean delivery. Results: Data from 220 women having undergone cesarean delivery were analyzed. The findings revealed that higher pre-operative pain catastrophizing scale (PCS) helplessness subscale (adjusted OR (aOR) 1.10, 95% confidence interval (CI) 1.03–1.17) and absence of medical comorbidity (aOR 1.87, 95% CI 1.00–3.50) were independently associated with primary cesarean delivery. Higher PCS total and subscales (rumination and magnification) scores were associated with primary cesarean delivery only in univariate analysis. Conclusions: Parturients undergoing primary cesarean delivery may benefit from early identification of pain catastrophizing, pre-emptive management of pain expectations, and optimization of perioperative analgesia to reduce pain-related morbidity.