Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Dr Badreldin, Ms Ditosto, and Dr Yee).
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Dr Badreldin, Ms Ditosto, and Dr Yee).
Am J Obstet Gynecol MFM. 2023 May;5(5):100908. doi: 10.1016/j.ajogmf.2023.100908. Epub 2023 Feb 19.
The experience of pain is shaped by a host of psychological, cultural, and social factors. Although pain is the most common postpartum complaint, data on its relationship with psychosocial factors and postpartum pain are limited.
This study aimed to examine the relationship between self-reported postpartum pain scores and patient-level psychosocial factors, including relationship status, pregnancy intendedness, employment, education, and psychiatric diagnosis.
This was a secondary analysis of data from a prospective observational study of postpartum patients at 1 institution (May 2017 to July 2019) who used an oral opioid at least once during their postpartum hospitalization. Enrolled participants completed a survey, which included questions regarding their social situation (including relationship status), psychiatric diagnoses, and perceptions of their pain control during their postpartum hospitalization. The primary outcome was self-reported overall pain during the postpartum hospitalization (score of 0-100). Multivariable analyses accounted for age, body mass index, nulliparity, and mode of delivery.
In this cohort of 494 postpartum patients, most patients (84.0%) underwent cesarean delivery, and 41.3% of patients were nulliparous. In a pain score of 0 to 100, participants reported a median pain score of 47. On bivariable analyses, there was no significant difference in pain score between patients with and without an unplanned pregnancy or a psychiatric diagnosis. Patients who were unpartnered, those without a college education, and those who were unemployed reported significantly higher pain scores (57.5 vs 44.8 [P<.01], 52.6 vs 44.6 [P<.01], and 53.6 vs 44.6 [P<.01], respectively). In multivariable analyses, patients who were unpartnered and unemployed reported significantly higher adjusted pain scores than patients who were partnered and employed (adjusted beta coefficients: 7.93 [95% confidence interval, 2.29-13.57] vs 6.67 [95% confidence interval, 2.28-11.05]).
Psychosocial factors, such as relationship and employment statuses, which are indicators of social support, are associated with the experience of pain postpartum. These findings suggest that addressing social support, such as via enhanced support from the health care team, warrants exploration as a nonpharmacologic means of improving the postpartum pain experience.
疼痛体验受到诸多心理、文化和社会因素的影响。尽管疼痛是产后最常见的问题，但有关其与心理社会因素之间关系的数据却很有限。
本研究旨在探讨患者报告的产后疼痛评分与患者水平的心理社会因素（包括关系状况、妊娠意图、就业、教育和精神科诊断）之间的关系。
这是对一家机构（2017 年 5 月至 2019 年 7 月）的产后患者进行的前瞻性观察性研究数据的二次分析，这些患者在产后住院期间至少使用过一次口服阿片类药物。入组的参与者完成了一项调查，其中包括有关其社会状况（包括关系状况）、精神科诊断以及对其产后住院期间疼痛控制的看法。主要结局是产后住院期间的自我报告总体疼痛（评分 0-100）。多变量分析考虑了年龄、体重指数、初产妇和分娩方式。
在这组 494 名产后患者中，大多数患者（84.0%）接受了剖宫产，41.3%的患者为初产妇。在 0 到 100 的疼痛评分中，参与者报告的中位数疼痛评分为 47。在单变量分析中，有计划妊娠和精神科诊断的患者之间的疼痛评分没有显著差异。无伴侣、未受过大学教育和失业的患者报告的疼痛评分明显更高（57.5 比 44.8 [P<.01]、52.6 比 44.6 [P<.01]和 53.6 比 44.6 [P<.01]）。在多变量分析中，无伴侣和失业的患者报告的调整后疼痛评分明显高于有伴侣和就业的患者（调整后β系数：7.93 [95%置信区间，2.29-13.57] 比 6.67 [95%置信区间，2.28-11.05]）。
社会支持的指标，如关系和就业状况等心理社会因素与产后疼痛体验相关。这些发现表明，解决社会支持问题，例如通过增强医疗保健团队的支持，可能是改善产后疼痛体验的一种非药物手段。
