Neuropathic pain in pregnant Turkish women with lumbopelvic pain and its impact on health-related quality of life

Association of Pain Catastrophizing and Depressive States with Multidimensional Early Labor Pain Assessment in Nulliparous Women Having Epidural Analgesia - A Secondary Analysis

Background

Labor pain is a variable and complex experience with both sensory and affective components. Pain catastrophizing tendencies are predictive of increased distress during labor. Likewise, pain severity has important associations with increased depressive symptoms in mothers, with consequences on perinatal and infant outcomes. Hence, we investigated the association between increased early labor pain with both pre-delivery pain catastrophizing and depressive states.

Methods

We recruited nulliparous women who had requested labor epidural analgesia. Pre-delivery questionnaires including short-form McGill pain questionnaire–2 (SF-MPQ-2), pain catastrophizing scale (PCS), and Edinburgh postnatal depression score (EPDS) were administered.

Results

A total of 712 women completed the pre-delivery questionnaires. There was a significant association between SF-MPQ-2 neuropathic subscale and EPDS ≥ 10 (unadjusted OR 1.74, 95% CI 1.11–2.73, p = 0.0161), as well as PCS ≥ 25 (unadjusted OR 1.55, 95% CI 1.06–2.26, p = 0.0244). SF-MPQ-2 sensory intermittent subscale and EPDS ≥ 10 (unadjusted OR 2.02, 95% CI 1.34–3.03, p = 0.0007), and PCS ≥ 25 (unadjusted OR 1.59, 95% CI 1.14–2.23, p = 0.0069) also showed significant association.

Conclusion

Increased sensory intermittent and neuropathic subsets of early labor pain are significantly correlated with increased pre-delivery pain catastrophizing and depressive states in nulliparous women. This positive association may be useful for pre-delivery risk stratification for early interventions towards a more holistic care management.

The associations of pregnancy-related symptoms with health-related quality of life at midpregnancy: the PregnActive project

AIM

To analyze the associations between the wide range of pregnancy-related symptoms and health-related quality of life.

MATERIAL AND METHODS

A cross-sectional study was developed among 155 healthy low-risk pregnant women, aged 18-45 years, participated in the study at midpregnancy. Health-related quality of life and pregnancy symptoms were assessed using the Medical Outcome Study 36-item short form questionnaire and the Pregnancy Symptoms Inventory, respectively. Simple correlations, hierarchical linear regressions and standard multiple regressions were performed.

RESULTS

Significant correlations, after adjusting for sociodemographic and anthropometric characteristics, were found between five pregnancy-related symptoms and physical component of health-related quality of life and between thirteen pregnancy-related symptoms and mental component. However, when all pregnancy symptoms were entered simultaneously into a multiple regression model, back pain and shortness of breath on the physical components, and feeling depressed and anxiety on the mental component were the main explanatory factors of health-related quality of life.

CONCLUSION

Among the wide range of pregnancy-related symptoms, back pain, hip or pelvic pain, shortness of breath, and feeling depressed and anxiety are the main symptoms affecting the physical and the mental components of health-related quality of life, respectively. An early detection of the pregnancy-related symptoms that may affect health-related quality of life enables early interventions aimed at ameliorating their negative impact on health-related quality of life and daily living activities at midpregnancy.

Association of Childbirth Pain with Postnatal Depressive and Anxiety Disorders in Nulliparous Parturients: A Prospective Study

PURPOSE

There is limited knowledge on the relationship between postnatal depression and childbirth pain characteristics associated with childbirth. We investigated whether the characteristics of childbirth pain, as assessed by Short-form-McGill Pain Questionnaire-2 (SF-MPQ-2), were associated with postnatal anxiety and depressive disorders.

PATIENTS AND METHODS

Nulliparous parturients who received labor epidural analgesia (LEA) and delivered in our institution were invited to have a Mini-International Neuropsychiatric Interview (MINI) assessment following their 5-9 weeks post-delivery follow-up phone survey of a larger study. Parturients' demographics, pre-delivery questionnaires on pain and psychological vulnerabilities, LEA data, maternal and neonatal outcomes, postnatal follow-up survey on pain and psychological vulnerabilities, pain and breastfeeding were collected accordingly. The primary outcome was the binary variable (yes/no) of the presence of postnatal depression and/or anxiety disorders based on the post-delivery MINI assessment.

RESULTS

Among the 107 parturients who participated in the post-delivery MINI assessment, a total of 40 (42.5%) patients were found to have postnatal anxiety and depressive disorders. A greater pre-delivery SF-MPQ-2 neuropathic pain mean subscale score (adjusted odds ratio (OR) 1.32, 95% CI 1.00-1.73, p=0.0482) and greater post-delivery Edinburgh Postnatal Depression Scale (EPDS) at 5-9 weeks post-delivery (adjusted OR 1.30, 95% CI 1.13-1.50, p=0.0002) were independently associated with the presence of postnatal anxiety and/or depressive disorders (receiver operating characteristic (ROC) = 0.7489).

CONCLUSION

Patients with greater pre-delivery neuropathic pain and higher EPDS scores at 5-9 weeks post-delivery are more likely to have postnatal depression and/or anxiety disorders, suggesting possible associations between pain and psychological vulnerability in the development of postnatal mental disorders.