St Luc Hospital University Catholic of Louvain Medical School, Brussels, Belgium.
Curr Opin Anaesthesiol. 2013 Jun;26(3):273-7. doi: 10.1097/ACO.0b013e328360c57b.
Although childbirth is considered a natural event, some deliveries may necessitate instrumentation or surgical intervention. In contrast with trauma or surgery, persistent pain after delivery has received little attention until recently, despite the large number of individuals potentially at risk.
Excluding pre-existing pain or pain that developed during pregnancy, prospective studies show a surprisingly low prevalence of persistent pain after childbirth, much lower than the prevalence reported in retrospective studies and that of persistent postsurgical pain in a general population for similar procedures. The nature of persistent pain itself remains poorly characterized; the chronic pain following caesarean delivery appears to be predominantly neuropathic, but the intensity is generally lower than usually reported for other types of chronic neuropathic pain. Finally, the type of delivery and the degree of tissue trauma do not seem to impact the risk of developing persistent pain. It is unclear whether individual factors place specific women at a risk for persistent pain. Experimental study suggests that protective mechanisms against the development of neuropathic pain may be active during the puerperium, but whether these mechanisms exist following human childbirth remains unknown.
Some recent findings on the development of persistent pain after childbirth are intriguing and might open the way to interesting perspectives for the treatment of persistent pain caused by trauma or surgery.
目的综述：尽管分娩被认为是一种自然事件，但某些分娩可能需要器械或手术干预。与创伤或手术不同，最近才开始关注分娩后持续性疼痛，尽管有大量潜在的风险人群，但关注程度远不及回顾性研究或类似手术的一般人群中的持续性手术后疼痛。
最新发现：排除预先存在的疼痛或在怀孕期间出现的疼痛，前瞻性研究显示，分娩后持续性疼痛的发生率令人惊讶地低，远低于回顾性研究报告的发生率，也低于类似手术的一般人群中持续性手术后疼痛的发生率。持续性疼痛本身的性质仍未得到很好的描述；剖宫产术后的慢性疼痛似乎主要是神经病理性的，但强度通常低于其他类型慢性神经病理性疼痛的通常报告。最后，分娩方式和组织创伤程度似乎并不影响发生持续性疼痛的风险。个体因素是否会使特定女性面临持续性疼痛的风险尚不清楚。实验研究表明，产后期可能存在对抗神经病理性疼痛发展的保护机制，但这些机制是否存在于人类分娩后仍不清楚。
总结：分娩后持续性疼痛发展的一些最新发现令人着迷，可能为创伤或手术引起的持续性疼痛的治疗开辟了有趣的前景。
