Holdcroft Anita, Snidvongs Saowarat, Cason Angie, Doré Caroline J, Berkley Karen J
Department of Anaesthesia, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK Program in Neuroscience, Tallahassee, FL 32306-1270, USA MRC Clinical Trials Unit, 222 Euston Road, London NW1 2DA, UK.
Pain. 2003 Aug;104(3):589-596. doi: 10.1016/S0304-3959(03)00116-7.
Previous research has shown that post-partum abdominal pain is greater in multiparous than primiparous women (Murray and Holdcroft, 1989). Although breast feeding in the immediate post-partum period induces uterine contractions and abdominal pain, it is unknown how parity influences the contractions. Here, a structured questionnaire that included the McGill Pain Questionnaire (total pain intensity index, TPI) and visual analog scales (VAS) was used to evaluate the intensity, location, referred tenderness (hyperalgesia), descriptor, and temporal characteristics of pain during breast feeding up to three days after uncomplicated vaginal delivery. Three groups of women were studied: primiparous (n=25); low parity (1-2 prior births; n=14); high parity (3-5 prior births; n=11). Uterine contractions during breast feeding were recorded using tocodynamometry in some women from each group (n=17, 6, 7, respectively). For comparison, an identical questionnaire was used to evaluate pains the women remembered experiencing during menstruation in the year immediately preceding the current pregnancy. During breast feeding, nearly all women (96%) reported deep pain primarily at three sites: lower abdomen, low back, and breast, with associated referred hyperalgesia in 62% of them. The intensity of these pains increased significantly with parity (P<0.001), along with an increase in the number of pain sites (P=0.03), mainly in lower abdomen and back, but not breast. Similarly, both the mean duration and number of uterine contractions increased significantly with parity (P<0.001). Furthermore, the mean duration of contractions correlated significantly with the pain scores (P=0.03 [VAS] and P=0.006 [TPI]). In contrast with pain during breast feeding, the intensity of pain during menstruation did not change with parity. These results demonstrate that pain, referred pain, and uterine contractions during breast feeding in the immediate post-partum period increase with parity, suggesting that childbirth can induce central neural changes that increase predisposition for pain during the post-partum period.
先前的研究表明，经产妇产后腹痛比初产妇更严重（默里和霍尔德克罗夫特，1989年）。尽管产后立即进行母乳喂养会引起子宫收缩和腹痛，但尚不清楚产次如何影响子宫收缩。在此，使用一份结构化问卷，其中包括麦吉尔疼痛问卷（总疼痛强度指数，TPI）和视觉模拟量表（VAS），来评估顺产无并发症的产妇产后三天内母乳喂养期间疼痛的强度、位置、牵涉压痛（痛觉过敏）、描述词和时间特征。研究了三组女性：初产妇（n = 25）；低产次（既往生育1 - 2次；n = 14）；高产次（既往生育3 - 5次；n = 11）。每组中部分女性（分别为n = 17、6、7）在母乳喂养期间使用宫缩描记法记录子宫收缩情况。为作比较，使用相同问卷评估这些女性在本次怀孕前一年月经期间记得经历过的疼痛。母乳喂养期间，几乎所有女性（96%）报告主要在三个部位有深部疼痛：下腹部、下背部和乳房，其中62%伴有牵涉痛觉过敏。这些疼痛的强度随产次显著增加（P < 0.001），疼痛部位数量也增加（P = 0.03），主要在下腹部和背部，而非乳房。同样，子宫收缩的平均持续时间和次数均随产次显著增加（P < 0.001）。此外，收缩的平均持续时间与疼痛评分显著相关（P = 0.03 [VAS]和P = 0.006 [TPI]）。与母乳喂养期间的疼痛不同，月经期间的疼痛强度不随产次变化。这些结果表明，产后立即进行母乳喂养期间的疼痛、牵涉痛和子宫收缩随产次增加，提示分娩可引起中枢神经变化，增加产后疼痛易感性。
