Carvalho B, Hilton G, Wen L, Weiniger C F
Department of Anesthesia, Stanford University School of Medicine, H3580, Stanford, CA 94305, USA
Department of Anesthesia, Stanford University School of Medicine, H3580, Stanford, CA 94305, USA.
Br J Anaesth. 2014 Sep;113(3):468-73. doi: 10.1093/bja/aeu149. Epub 2014 Jun 6.
Assessments of labour pain focus on pain intensity, not on duration. We aimed to assess the importance labouring women apply to pain intensity and duration before labour and post-delivery.
Forty healthy women scheduled for labour induction were enrolled in this institutional review board-approved, prospective cohort study. Participants completed a pain preference questionnaire before active labour and within 24-h of delivery. The questionnaire consisted of seven stem questions that evaluated preference for pain intensity or duration. The pain preference ratio was determined by dividing the percentage of women who preferred reduced pain intensity for longer duration by that of those who preferred greater pain intensity for shorter duration (estimate of the odds). The overall hypothetical pain burden was determined by multiplying intensity by time. All questions presented the same overall hypothetical pain burden.
Pain preference questionnaire scores demonstrated preference for low intensity pain for a longer duration rather than higher intensity for a shorter duration, both pre-labour (P<0.001) and post-delivery (P<0.001): the null median imputed as 3 of 6 (i.e. no preference for pain intensity over pain duration). This preference for pain duration over intensity was greater post-delivery compared with before labour (P=0.03). There was a significant correlation (r=0.83; P=0.04) between the pain preference ratio vs overall hypothetical pain burden before labour but not after delivery (r=0.28; P=0.59).
In this preliminary labour assessment, women preferred lower pain intensity at the cost of longer pain duration. This suggests that pain intensity is the primary driver of hypothetical pain burden-a preference reinforced post-delivery.
对分娩疼痛的评估侧重于疼痛强度，而非持续时间。我们旨在评估即将分娩的女性在分娩前和产后对疼痛强度和持续时间的重视程度。
本前瞻性队列研究经机构审查委员会批准，纳入了40名计划引产的健康女性。参与者在活跃分娩前和分娩后24小时内完成了一份疼痛偏好问卷。该问卷由七个主干问题组成，评估对疼痛强度或持续时间的偏好。疼痛偏好比率通过将偏好较长持续时间的较低疼痛强度的女性百分比除以偏好较短持续时间的较高疼痛强度的女性百分比来确定（优势估计）。总体假设疼痛负担通过强度乘以时间来确定。所有问题呈现的总体假设疼痛负担相同。
疼痛偏好问卷得分显示，无论是在分娩前（P < 0.001）还是分娩后（P < 0.001），女性都偏好低强度疼痛持续较长时间，而非高强度疼痛持续较短时间：无效中位数被推算为6分中的3分（即对疼痛强度和疼痛持续时间无偏好）。与分娩前相比，分娩后对疼痛持续时间而非强度的这种偏好更大（P = 0.03）。分娩前疼痛偏好比率与总体假设疼痛负担之间存在显著相关性（r = 0.83；P = 0.04），但分娩后不存在（r = 0.28；P = 0.59）。
在这项初步的分娩评估中，女性偏好较低的疼痛强度，即使这意味着疼痛持续时间会更长。这表明疼痛强度是假设疼痛负担的主要驱动因素——这种偏好在分娩后得到强化。
