Berlit Sebastian, Lis Stefanie, Häfner Katharina, Kleindienst Nikolaus, Baumgärtner Ulf, Treede Rolf-Detlef, Sütterlin Marc, Schmahl Christian
Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.
Arch Gynecol Obstet. 2018 Mar;297(3):591-599. doi: 10.1007/s00404-017-4605-4. Epub 2017 Dec 1.
To analyse post-partum short- and long-term pain sensitivity and the influence of endogenous pain inhibition as well as distinct psycho-social factors on birth-related pain.
Pain sensitivity was assessed in 91 primiparous women at three times: 2-6 weeks before, one to 3 days as well as ten to 14 weeks after childbirth. Application of a pressure algometer in combination with a cold pressor test was utilised for measurement of pain sensitivity and assessment of conditioned pain modulation (CPM). Selected psycho-social factors (anxiety, social support, history of abuse, chronic pain and fear of childbirth) were evaluated with standardised questionnaires and their effect on pain processing then analysed.
Pressure pain threshold, cold pain threshold and cold pain tolerance increased significantly directly after birth (all p < 0.001). While cold pain parameters partly recovered on follow-up, pressure pain threshold remained increased above baseline (p < 0.001). These pain-modulating effects were not found for women with history of abuse. While CPM was not affected by birth, its extent correlated significantly (r = 0.367) with the drop in pain sensitivity following birth. Moreover, high trait anxiety predicted an attenuated reduction in pain sensitivity (r = 0.357), while there was no correlation with fear of childbirth, chronic pain and social support.
Pain sensitivity showed a decrease when comparing post-partum with prepartum values. The extent and direction of CPM appear to be a trait variable that predicted post-partum hypalgesia without being changed itself. Post-partum hypalgesia was reduced in women with a history of abuse and high trait anxiety, which suggests that individual differences in CPM affect childbirth experience.
分析产后短期和长期的疼痛敏感性、内源性疼痛抑制的影响以及不同心理社会因素对分娩相关疼痛的影响。
对91名初产妇在三个时间点进行疼痛敏感性评估：分娩前2 - 6周、分娩后1至3天以及10至14周。使用压力痛觉计结合冷加压试验来测量疼痛敏感性并评估条件性疼痛调制（CPM）。通过标准化问卷评估选定的心理社会因素（焦虑、社会支持、虐待史、慢性疼痛和分娩恐惧），然后分析它们对疼痛处理的影响。
分娩后即刻，压力痛阈、冷痛阈和冷痛耐受性均显著增加（均p < 0.001）。虽然冷痛参数在随访时部分恢复，但压力痛阈仍高于基线水平（p < 0.001）。有虐待史的女性未发现这些疼痛调节效应。虽然CPM不受分娩影响，但其程度与分娩后疼痛敏感性的下降显著相关（r = 0.367）。此外，高特质焦虑预示着疼痛敏感性降低幅度减小（r = 0.357），而与分娩恐惧、慢性疼痛和社会支持无关。
与产前值相比，产后疼痛敏感性降低。CPM的程度和方向似乎是一个特质变量，可预测产后痛觉减退，但其本身并未改变。有虐待史和高特质焦虑的女性产后痛觉减退程度降低，这表明CPM的个体差异会影响分娩体验。
