Chan Joel Chee Yee, Sultana Rehena, Mathur Deepak, Tan Chin Wen, Sng Ban Leong
Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore, Singapore.
Ministry of Health Holdings, Singapore, Singapore.
Can J Anaesth. 2025 Apr;72(4):603-614. doi: 10.1007/s12630-025-02920-8. Epub 2025 Mar 20.
Pain catastrophizing is an amplified negative thought process that emerges during actual or perceived pain moments. There is limited information on the role of labour pain in the development of pain catastrophizing during the postpartum period. We sought to investigate whether labour pain, pain, and psychological vulnerabilities are associated with high pain catastrophizing (defined as a Pain Catastrophizing Scale [PCS] ≥ 25) at 6-10 weeks postpartum.
We conducted a secondary analysis of a randomized controlled trial that recruited pregnant individuals at term prior to labour and delivery. Participants filled in the predelivery questionnaires on labour pain, pain, and psychological vulnerabilities upon written consent. The recruited parturients also completed an online survey 6-10 weeks postpartum to determine the status of pain catastrophizing.
Among the 820 parturients who completed the postpartum online survey, 116 (14.4%) were high pain catastrophizing. Multivariate logistic regression analysis found that greater enormity of labour pain (adjusted odds ratio [aOR], 1.04; 95% confidence interval [CI], 1.02 to 1.06), choosing nonepidural over epidural analgesia (aOR, 1.84; 95% CI, 1.17 to 2.91), having a family history of other mental disorders (aOR, 31.3; 95% CI, 5.7 to 173.7), greater predelivery pain catastrophizing (aOR, 2.70; 95% CI, 1.68 to 4.36), greater predelivery activity avoidance (aOR, 1.06; 95% CI, 1.04 to 1.09), and greater predelivery state anxiety (aOR, 1.03; 95% CI, 1.01 to 1.05) were associated with postpartum pain catastrophizing at 6-10 weeks postpartum. Having greater infant weight was protective against the risk of postpartum pain catastrophizing (aOR, 0.43; 95% CI, 0.23 to 0.78). The area under the curve of the generated multivariable model was 0.82 (95% CI, 0.78 to 0.86).
Predelivery pain and psychological vulnerabilities were associated with postpartum pain catastrophizing among healthy parturients undergoing labour. Future prospective studies are needed to evaluate whether such risk factors can allow earlier intervention to reduce pain catastrophizing.
ClinicalTrials.gov ( NCT03167905 ); first submitted 30 May 2017.
疼痛灾难化是在实际疼痛或感知到疼痛时出现的一种放大的消极思维过程。关于分娩疼痛在产后疼痛灾难化发展过程中的作用，相关信息有限。我们试图调查分娩疼痛、疼痛及心理易损性是否与产后6 - 10周时的高疼痛灾难化（定义为疼痛灾难化量表[PCS]≥25）相关。
我们对一项随机对照试验进行了二次分析，该试验在分娩前招募足月孕妇。参与者在书面同意后填写关于分娩疼痛、疼痛及心理易损性的产前问卷。招募的产妇在产后6 - 10周还完成了一项在线调查，以确定疼痛灾难化的状况。
在完成产后在线调查的820名产妇中，116名（14.4%）为高疼痛灾难化。多因素逻辑回归分析发现，分娩疼痛程度越高（调整比值比[aOR]，1.04；95%置信区间[CI]，1.02至1.06）、选择非硬膜外镇痛而非硬膜外镇痛（aOR，1.84；95% CI，1.17至2.91）、有其他精神障碍家族史（aOR，31.3；95% CI，5.7至173.7）、产前疼痛灾难化程度越高（aOR，2.70；95% CI，1.68至4.36）、产前活动回避程度越高（aOR，1.06；95% CI，1.04至1.09）以及产前状态焦虑程度越高（aOR，1.03；95% CI，1.01至1.05）与产后6 - 10周的疼痛灾难化相关。婴儿体重越大对产后疼痛灾难化风险具有保护作用（aOR，0.43；95% CI，0.23至0.78）。所构建的多变量模型的曲线下面积为0.82（95% CI，0.78至0.86）。
产前疼痛和心理易损性与分娩的健康产妇产后疼痛灾难化相关。未来需要进行前瞻性研究，以评估这些风险因素是否能实现早期干预以减轻疼痛灾难化。
ClinicalTrials.gov（NCT03167905）；首次提交于2017年5月30日。
