Prevalence and risk factors of chronic pain after cesarean section: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Yuanyuan ^1,2 , LIU Hongyuan ^1,2 , CHEN Ying ¹ , YU Xiaoping ² , ZHANG Yan ² ,  KONG Xiang ^3,4

1. School of Nursing, Yangzhou University, Yangzhou 225100, P.R.China;
2. Department of Nursing, Yizheng People's Hospital, Yizheng 211400, P.R.China;
3. Medical College of Yangzhou University, Yangzhou 225100, P.R.China;
4. Department of Obstetrics and Gynecology, Northern Jiangsu People's Hospital, Yangzhou 225100, P.R.China;

Corresponding author：

KONG Xiang, Email: XKong@yzu.edu.cn

Keywords：

Cesarean section; Chronic post-surgical pain; Prevalence; Risk factor; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.202106062

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To systematically review the prevalence and risk factors of the chronic post-cesarean section pain (CPCSP). Methods PubMed, EMbase, The Cochrane Library, CINAHL, PsycInfo, CBM, WanFang Data, VIP, and CNKI databases were electronically searched to collect studies on the prevalence and risk factors of CPCSP from inception to August 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Meta-analysis was then performed using Stata 15.1 software. Results A total of 43 studies involving 12 435 participants were included. The results of meta-analysis showed that the prevalence of CPCSP for 2 to 5 months, 6 to 11 months, and at least 12 months were 19% (95%CI 15% to 23%), 13% (95%CI 9% to 17%), and 8% (95%CI 6% to 10%), respectively. The risk factors included preoperative pain present elsewhere, postoperative severe acute pain, low abdominal transverse incision, non-intrathecal administration of morphine, preoperative anxiety, postpartum depression, etc. Conclusions The current evidence shows that the overall prevalence of CPCSP is high. Preoperative pain presents elsewhere, postoperative severe acute pain, low abdominal transverse incision, non-intrathecal administration of morphine, preoperative anxiety and postpartum depression may increase the risk of CPCSP.

Citation： WANG Yuanyuan, LIU Hongyuan, CHEN Ying, YU Xiaoping, ZHANG Yan, KONG Xiang. Prevalence and risk factors of chronic pain after cesarean section: a systematic review. Chinese Journal of Evidence-Based Medicine, 2021, 21(10): 1195-1202. doi: 10.7507/1672-2531.202106062 Copy

1.	Macrae WA, Davies HT. Chronic postsurgical pain. Epidemiology of pain. Seattle: IASP, 1999: 125-142.
2.	Mills SEE, Nicolson KP, Smith BH. Chronic pain: a review of its epidemiology and associated factors in population-based studies. Br J Anaesth, 2019, 123(2): 273-283.
3.	Molina G, Weiser TG, Lipsitz SR, et al. Relationship between cesarean delivery rate and maternal and neonatal mortality. JAMA, 2015, 314(21): 2263-2270.
4.	Sun KW, Pan PH. Persistent pain after cesarean delivery. Int J Obstet Anesth, 2019, 40: 78-90.
5.	顾向应, 张雪松. "全面二孩"政策下关注再生育现状, 积极做好再生育全程管理. 中国实用妇科与产科杂志, 2020, 36(1): 65-69.
6.	Lavand'homme P. Postpartum chronic pain. Minerva Anestesiol, 2019, 85(3): 320-324.
7.	Nikolajsen L, Sørensen HC, Jensen TS, et al. Chronic pain following caesarean section. Acta Anaesthesiol Scand, 2004, 48(1): 111-116.
8.	Niklasson B, Georgsson Öhman S, Segerdahl M, et al. Risk factors for persistent pain and its influence on maternal wellbeing after cesarean section. Acta Obstet Gynecol Scand, 2015, 94(6): 622-628.
9.	O'Neill P, Duarte F, Ribeiro I, et al. Ropivacaine continuous wound infusion versus epidural morphine for postoperative analgesia after cesarean delivery: a randomized controlled trial. Anesth Analg, 2012, 114(1): 179-185.
10.	Woolhouse H, Perlen S, Gartland D, et al. Physical health and recovery in the first 18 months postpartum: does cesarean section reduce long-term morbidity. Birth, 2012, 39(3): 221-229.
11.	曾宪涛, 刘慧, 陈曦, 等. Meta 分析系列之四: 观察性研究的质量评价工具. 中国循证心血管医学杂志, 2012, 4(4): 297-299.
12.	曾宪涛, 包翠萍, 曹世义, 等. Meta 分析系列之三: 随机对照试验的质量评价工具. 中国循证心血管医学杂志, 2012, 4(3): 183-185.
13.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions, 2014-02-25. Available at: http://handbook.cochrane.org/.
14.	Lavand'homme PM, Roelants F, Waterloos H, et al. Postoperative analgesic effects of continuous wound infiltration with diclofenac after elective cesarean delivery. Anesthesiology, 2007, 106(6): 1220-1225.
15.	Eisenach JC, Pan PH, Smiley R, et al. Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression. Pain, 2008, 140(1): 87-94.
16.	Declercq E, Cunningham DK, Johnson C, et al. Mothers' reports of postpartum pain associated with vaginal and cesarean deliveries: results of a national survey. Birth, 2008, 35(1): 16-24.
17.	Lavand'homme PM, Roelants F, Waterloos H, et al. An evaluation of the postoperative antihyperalgesic and analgesic effects of intrathecal clonidine administered during elective cesarean delivery. Anesth Analg, 2008, 107(3): 948-955.
18.	Shahin AY, Osman AM. Parietal peritoneal closure and persistent postcesarean pain. Int J Gynaecol Obstet, 2009, 104(2): 135-139.
19.	Sng BL, Sia AT, Quek K, et al. Incidence and risk factors for chronic pain after caesarean section under spinal anaesthesia. Anaesth Intensive Care, 2009, 37(5): 748-752.
20.	Kainu JP, Sarvela J, Tiippana E, et al. Persistent pain after caesarean section and vaginal birth: a cohort study. Int J Obstet Anesth, 2010, 19(1): 4-9.
21.	Sia AT, Sng BL, Lim EC, et al. The influence of ATP-binding cassette sub-family B member -1 (ABCB1) genetic polymorphisms on acute and chronic pain after intrathecal morphine for caesarean section: a prospective cohort study. Int J Obstet Anesth, 2010, 19(3): 254-260.
22.	Wang BS, Zhou LF, Coulter D, et al. Effects of caesarean section on maternal health in low risk nulliparous women: a prospective matched cohort study in Shanghai, China. BMC Pregnancy Childbirth, 2010, 10: 78.
23.	Rackelboom T, Strat SL, Silvera S, et al. Improving continuous wound infusion effectiveness for postoperative analgesia after cesarean delivery: a randomized controlled trial. Obstet Gynecol, 2010, 116(4): 893-900.
24.	Shahin AY, Osman AM. Intraperitoneal lidocaine instillation and postcesarean pain after parietal peritoneal closure: a randomized double blind placebo-controlled trial. Clin J Pain, 2010, 26(2): 121-127.
25.	Moore A, Costello J, Wieczorek P, et al. Gabapentin improves postcesarean delivery pain management: a randomized, placebo-controlled trial. Anesth Analg, 2011, 112(1): 167-173.
26.	de Brito Cançado TO, Omais M, Ashmawi HA, et al. Chronic pain after cesarean section. Influence of anesthetic/surgical technique and postoperative analgesia. Rev Bras Anestesiol, 2012, 62(6): 762-774.
27.	Bilgen S, Köner O, Türe H, et al. Effect of three different doses of ketamine prior to general anaesthesia on postoperative pain following Caesarean delivery: a prospective randomized study. Minerva Anestesiol, 2012, 78(4): 442-449.
28.	Loane H, Preston R, Douglas MJ, et al. A randomized controlled trial comparing intrathecal morphine with transversus abdominis plane block for post-cesarean delivery analgesia. Int J Obstet Anesth, 2012, 21(2): 112-118.
29.	Short J, Downey K, Bernstein P, et al. A single preoperative dose of gabapentin does not improve postcesarean delivery pain management: a randomized, double-blind, placebo-controlled dose-finding trial. Anesth Analg, 2012, 115(6): 1336-1342.
30.	Suppa E, Valente A, Catarci S, et al. A study of low-dose S-ketamine infusion as "preventive" pain treatment for cesarean section with spinal anesthesia: benefits and side effects. Minerva Anestesiol, 2012, 78(7): 774-781.
31.	Liu TT, Raju A, Boesel T, et al. Chronic pain after caesarean delivery: an Australian cohort. Anaesth Intensive Care, 2013, 41(4): 496-500.
32.	Nawaz YM, Parks L, Bell PF. Wound infection is significantly associated with chronic pain after caesarean section. Int J Obstet Anesth, 2013, 22: 42.
33.	Eldaba AA, Amr YM, Sobhy RA. Effect of wound infiltration with bupivacaine or lower dose bupivacaine/magnesium versus placebo for postoperative analgesia after cesarean section. Anesth Essays Res, 2013, 7(3): 336-340.
34.	Ortner CM, Turk DC, Theodore BR, et al. The Short-form McGill pain questionnaire-revised to evaluate persistent pain and surgery-related symptoms in healthy women undergoing a planned cesarean delivery. Reg Anesth Pain Med, 2014, 39(6): 478-486.
35.	Rezaie Kahkhaie K, Rezaie Keikhaie K, Shahreki Vahed A, et al. Randomized comparison of nylon versus absorbing polyglactin 910 for fascial closure in caesarean section. Iran Red Crescent Med J, 2014, 16(4): e12580.
36.	Belci D, Di Renzo GC, Stark M, et al. Morbidity and chronic pain following different techniques of caesarean section: a comparative study. J Obstet Gynaecol, 2015, 35(5): 442-446.
37.	Richez B, Ouchchane L, Guttmann A, et al. The role of psychological factors in persistent pain after cesarean delivery. J Pain, 2015, 16(11): 1136-1146.
38.	Jin J, Peng L, Chen Q, et al. Prevalence and risk factors for chronic pain following cesarean section: a prospective study. BMC Anesthesiol, 2016, 16(1): 99.
39.	Kainu JP, Halmesmäki E, Korttila KT, et al. Persistent pain after cesarean delivery and vaginal delivery: a prospective cohort study. Anesth Analg, 2016, 123(6): 1535-1545.
40.	Brotons MJS, Echevarria M, Turmo M. Chronic pain and predictive factors in the C-section surgery. Anesth Clin Care, 2016, 3(1): 1-6.
41.	Booth JL, Harris LC, Eisenach JC, et al. A randomized controlled trial comparing two multimodal analgesic techniques in patients predicted to have severe pain after cesarean delivery. Anesth Analg, 2016, 122(4): 1114-1119.
42.	Moriyama K, Ohashi Y, Motoyasu A, et al. Intrathecal administration of morphine decreases persistent pain after cesarean section: a prospective observational study. PLoS One, 2016, 11(5): e0155114.
43.	Daly B, Young S, Marla R, et al. Persistent pain after caesarean section and its association with maternal anxiety and socioeconomic background. Int J Obstet Anesth, 2017, 29: 57-63.
44.	Wang LZ, Wei CN, Xiao F, et al. Incidence and risk factors for chronic pain after elective caesarean delivery under spinal anaesthesia in a Chinese cohort: a prospective study. Int J Obstet Anesth, 2018, 34: 21-27.
45.	何后仲, 闫芳然. 硬膜外麻醉下剖宫产术后慢性腰痛的危险因素分析. 实用医药杂志, 2018, 35(11): 985-988.
46.	Ma G, Yang J, Zhao B, et al. Correlation between CCL2, CALCA, and CX3CL1 gene polymorphisms and chronic pain after cesarean section in Chinese Han women: a case control study. Medicine (Baltimore), 2019, 98(34): e16706.
47.	Wang L, Wei C, Xiao F, et al. Influences of COMT rs4680 and OPRM1 rs1799971 polymorphisms on chronic postsurgical pain, acute pain, and analgesic consumption after elective cesarean delivery. Clin J Pain, 2019, 35(1): 31-36.
48.	Borys M, Potręć-Studzińska B, Wiech M, et al. Transversus abdominis plane block and quadratus lumborum block did not reduce the incidence or severity of chronic postsurgical pain following cesarean section: a prospective, observational study. Anaesthesiol Intensive Ther, 2019, 51(4): 257-261.
49.	Borges NC, de Deus JM, Guimarães RA, et al. The incidence of chronic pain following Cesarean section and associated risk factors: a cohort of women followed up for three months. PLoS One, 2020, 15(9): e0238634.
50.	Nimmaanrat S, Wongwiwattananon W, Siripreukpong S, et al. A prospective observational study to investigate the relationship between local anesthetic infiltration pain before spinal anesthesia and acute and chronic postsurgical pain in women undergoing elective cesarean delivery. Int J Obstet Anesth, 2021, 45: 56-60.
51.	Fassoulaki A, Staikou C, Tsaroucha A, et al. Acute and chronic pain after cesarean delivery under subarachnoid anaesthesia. Is postoperative analgesia adequate? A cohort observational study. Maedica (Bucur), 2021, 16(1): 41-47.
52.	夏苗静, 洪燕, 余幼芬, 等. 剖宫产术后慢性疼痛的危险因素分析. 中国妇幼保健, 2021, 36(10): 2354-2357.
53.	Bayman EO, Brennan TJ. Incidence and severity of chronic pain at 3 and 6 months after thoracotomy: meta-analysis. J Pain, 2014, 15(9): 887-897.
54.	Gong Y, Tan Q, Qin Q, et al. Prevalence of postmastectomy pain syndrome and associated risk factors: a large single-institution cohort study. Medicine (Baltimore), 2020, 99(20): e19834.
55.	Yimer H, Woldie H. Incidence and associated factors of chronic pain after caesarean section: a systematic review. J Obstet Gynaecol Can, 2019, 41(6): 840-854.
56.	Weibel S, Neubert K, Jelting Y, et al. Incidence and severity of chronic pain after caesarean section: A systematic review with meta-analysis. Eur J Anaesthesiol, 2016, 33(11): 853-865.
57.	Keene DJ, Knight R, Bruce J, et al. Chronic pain with neuropathic characteristics after surgery for major trauma to the lower limb: prevalence, predictors, and association with pain severity, disability, and quality of life in the UK WHiST trial. Bone Joint J, 2021, 103-B(6): 1047-1054.

1. Macrae WA, Davies HT. Chronic postsurgical pain. Epidemiology of pain. Seattle: IASP, 1999: 125-142.
2. Mills SEE, Nicolson KP, Smith BH. Chronic pain: a review of its epidemiology and associated factors in population-based studies. Br J Anaesth, 2019, 123(2): 273-283.
3. Molina G, Weiser TG, Lipsitz SR, et al. Relationship between cesarean delivery rate and maternal and neonatal mortality. JAMA, 2015, 314(21): 2263-2270.
4. Sun KW, Pan PH. Persistent pain after cesarean delivery. Int J Obstet Anesth, 2019, 40: 78-90.
5. 顾向应, 张雪松. "全面二孩"政策下关注再生育现状, 积极做好再生育全程管理. 中国实用妇科与产科杂志, 2020, 36(1): 65-69.
6. Lavand'homme P. Postpartum chronic pain. Minerva Anestesiol, 2019, 85(3): 320-324.
7. Nikolajsen L, Sørensen HC, Jensen TS, et al. Chronic pain following caesarean section. Acta Anaesthesiol Scand, 2004, 48(1): 111-116.
8. Niklasson B, Georgsson Öhman S, Segerdahl M, et al. Risk factors for persistent pain and its influence on maternal wellbeing after cesarean section. Acta Obstet Gynecol Scand, 2015, 94(6): 622-628.
9. O'Neill P, Duarte F, Ribeiro I, et al. Ropivacaine continuous wound infusion versus epidural morphine for postoperative analgesia after cesarean delivery: a randomized controlled trial. Anesth Analg, 2012, 114(1): 179-185.
10. Woolhouse H, Perlen S, Gartland D, et al. Physical health and recovery in the first 18 months postpartum: does cesarean section reduce long-term morbidity. Birth, 2012, 39(3): 221-229.
11. 曾宪涛, 刘慧, 陈曦, 等. Meta 分析系列之四: 观察性研究的质量评价工具. 中国循证心血管医学杂志, 2012, 4(4): 297-299.
12. 曾宪涛, 包翠萍, 曹世义, 等. Meta 分析系列之三: 随机对照试验的质量评价工具. 中国循证心血管医学杂志, 2012, 4(3): 183-185.
13. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions, 2014-02-25. Available at: http://handbook.cochrane.org/.
14. Lavand'homme PM, Roelants F, Waterloos H, et al. Postoperative analgesic effects of continuous wound infiltration with diclofenac after elective cesarean delivery. Anesthesiology, 2007, 106(6): 1220-1225.
15. Eisenach JC, Pan PH, Smiley R, et al. Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression. Pain, 2008, 140(1): 87-94.
16. Declercq E, Cunningham DK, Johnson C, et al. Mothers' reports of postpartum pain associated with vaginal and cesarean deliveries: results of a national survey. Birth, 2008, 35(1): 16-24.
17. Lavand'homme PM, Roelants F, Waterloos H, et al. An evaluation of the postoperative antihyperalgesic and analgesic effects of intrathecal clonidine administered during elective cesarean delivery. Anesth Analg, 2008, 107(3): 948-955.
18. Shahin AY, Osman AM. Parietal peritoneal closure and persistent postcesarean pain. Int J Gynaecol Obstet, 2009, 104(2): 135-139.
19. Sng BL, Sia AT, Quek K, et al. Incidence and risk factors for chronic pain after caesarean section under spinal anaesthesia. Anaesth Intensive Care, 2009, 37(5): 748-752.
20. Kainu JP, Sarvela J, Tiippana E, et al. Persistent pain after caesarean section and vaginal birth: a cohort study. Int J Obstet Anesth, 2010, 19(1): 4-9.
21. Sia AT, Sng BL, Lim EC, et al. The influence of ATP-binding cassette sub-family B member -1 (ABCB1) genetic polymorphisms on acute and chronic pain after intrathecal morphine for caesarean section: a prospective cohort study. Int J Obstet Anesth, 2010, 19(3): 254-260.
22. Wang BS, Zhou LF, Coulter D, et al. Effects of caesarean section on maternal health in low risk nulliparous women: a prospective matched cohort study in Shanghai, China. BMC Pregnancy Childbirth, 2010, 10: 78.
23. Rackelboom T, Strat SL, Silvera S, et al. Improving continuous wound infusion effectiveness for postoperative analgesia after cesarean delivery: a randomized controlled trial. Obstet Gynecol, 2010, 116(4): 893-900.
24. Shahin AY, Osman AM. Intraperitoneal lidocaine instillation and postcesarean pain after parietal peritoneal closure: a randomized double blind placebo-controlled trial. Clin J Pain, 2010, 26(2): 121-127.
25. Moore A, Costello J, Wieczorek P, et al. Gabapentin improves postcesarean delivery pain management: a randomized, placebo-controlled trial. Anesth Analg, 2011, 112(1): 167-173.
26. de Brito Cançado TO, Omais M, Ashmawi HA, et al. Chronic pain after cesarean section. Influence of anesthetic/surgical technique and postoperative analgesia. Rev Bras Anestesiol, 2012, 62(6): 762-774.
27. Bilgen S, Köner O, Türe H, et al. Effect of three different doses of ketamine prior to general anaesthesia on postoperative pain following Caesarean delivery: a prospective randomized study. Minerva Anestesiol, 2012, 78(4): 442-449.
28. Loane H, Preston R, Douglas MJ, et al. A randomized controlled trial comparing intrathecal morphine with transversus abdominis plane block for post-cesarean delivery analgesia. Int J Obstet Anesth, 2012, 21(2): 112-118.
29. Short J, Downey K, Bernstein P, et al. A single preoperative dose of gabapentin does not improve postcesarean delivery pain management: a randomized, double-blind, placebo-controlled dose-finding trial. Anesth Analg, 2012, 115(6): 1336-1342.
30. Suppa E, Valente A, Catarci S, et al. A study of low-dose S-ketamine infusion as "preventive" pain treatment for cesarean section with spinal anesthesia: benefits and side effects. Minerva Anestesiol, 2012, 78(7): 774-781.
31. Liu TT, Raju A, Boesel T, et al. Chronic pain after caesarean delivery: an Australian cohort. Anaesth Intensive Care, 2013, 41(4): 496-500.
32. Nawaz YM, Parks L, Bell PF. Wound infection is significantly associated with chronic pain after caesarean section. Int J Obstet Anesth, 2013, 22: 42.
33. Eldaba AA, Amr YM, Sobhy RA. Effect of wound infiltration with bupivacaine or lower dose bupivacaine/magnesium versus placebo for postoperative analgesia after cesarean section. Anesth Essays Res, 2013, 7(3): 336-340.
34. Ortner CM, Turk DC, Theodore BR, et al. The Short-form McGill pain questionnaire-revised to evaluate persistent pain and surgery-related symptoms in healthy women undergoing a planned cesarean delivery. Reg Anesth Pain Med, 2014, 39(6): 478-486.
35. Rezaie Kahkhaie K, Rezaie Keikhaie K, Shahreki Vahed A, et al. Randomized comparison of nylon versus absorbing polyglactin 910 for fascial closure in caesarean section. Iran Red Crescent Med J, 2014, 16(4): e12580.
36. Belci D, Di Renzo GC, Stark M, et al. Morbidity and chronic pain following different techniques of caesarean section: a comparative study. J Obstet Gynaecol, 2015, 35(5): 442-446.
37. Richez B, Ouchchane L, Guttmann A, et al. The role of psychological factors in persistent pain after cesarean delivery. J Pain, 2015, 16(11): 1136-1146.
38. Jin J, Peng L, Chen Q, et al. Prevalence and risk factors for chronic pain following cesarean section: a prospective study. BMC Anesthesiol, 2016, 16(1): 99.
39. Kainu JP, Halmesmäki E, Korttila KT, et al. Persistent pain after cesarean delivery and vaginal delivery: a prospective cohort study. Anesth Analg, 2016, 123(6): 1535-1545.
40. Brotons MJS, Echevarria M, Turmo M. Chronic pain and predictive factors in the C-section surgery. Anesth Clin Care, 2016, 3(1): 1-6.
41. Booth JL, Harris LC, Eisenach JC, et al. A randomized controlled trial comparing two multimodal analgesic techniques in patients predicted to have severe pain after cesarean delivery. Anesth Analg, 2016, 122(4): 1114-1119.
42. Moriyama K, Ohashi Y, Motoyasu A, et al. Intrathecal administration of morphine decreases persistent pain after cesarean section: a prospective observational study. PLoS One, 2016, 11(5): e0155114.
43. Daly B, Young S, Marla R, et al. Persistent pain after caesarean section and its association with maternal anxiety and socioeconomic background. Int J Obstet Anesth, 2017, 29: 57-63.
44. Wang LZ, Wei CN, Xiao F, et al. Incidence and risk factors for chronic pain after elective caesarean delivery under spinal anaesthesia in a Chinese cohort: a prospective study. Int J Obstet Anesth, 2018, 34: 21-27.
45. 何后仲, 闫芳然. 硬膜外麻醉下剖宫产术后慢性腰痛的危险因素分析. 实用医药杂志, 2018, 35(11): 985-988.
46. Ma G, Yang J, Zhao B, et al. Correlation between CCL2, CALCA, and CX3CL1 gene polymorphisms and chronic pain after cesarean section in Chinese Han women: a case control study. Medicine (Baltimore), 2019, 98(34): e16706.
47. Wang L, Wei C, Xiao F, et al. Influences of COMT rs4680 and OPRM1 rs1799971 polymorphisms on chronic postsurgical pain, acute pain, and analgesic consumption after elective cesarean delivery. Clin J Pain, 2019, 35(1): 31-36.
48. Borys M, Potręć-Studzińska B, Wiech M, et al. Transversus abdominis plane block and quadratus lumborum block did not reduce the incidence or severity of chronic postsurgical pain following cesarean section: a prospective, observational study. Anaesthesiol Intensive Ther, 2019, 51(4): 257-261.
49. Borges NC, de Deus JM, Guimarães RA, et al. The incidence of chronic pain following Cesarean section and associated risk factors: a cohort of women followed up for three months. PLoS One, 2020, 15(9): e0238634.
50. Nimmaanrat S, Wongwiwattananon W, Siripreukpong S, et al. A prospective observational study to investigate the relationship between local anesthetic infiltration pain before spinal anesthesia and acute and chronic postsurgical pain in women undergoing elective cesarean delivery. Int J Obstet Anesth, 2021, 45: 56-60.
51. Fassoulaki A, Staikou C, Tsaroucha A, et al. Acute and chronic pain after cesarean delivery under subarachnoid anaesthesia. Is postoperative analgesia adequate? A cohort observational study. Maedica (Bucur), 2021, 16(1): 41-47.
52. 夏苗静, 洪燕, 余幼芬, 等. 剖宫产术后慢性疼痛的危险因素分析. 中国妇幼保健, 2021, 36(10): 2354-2357.
53. Bayman EO, Brennan TJ. Incidence and severity of chronic pain at 3 and 6 months after thoracotomy: meta-analysis. J Pain, 2014, 15(9): 887-897.
54. Gong Y, Tan Q, Qin Q, et al. Prevalence of postmastectomy pain syndrome and associated risk factors: a large single-institution cohort study. Medicine (Baltimore), 2020, 99(20): e19834.
55. Yimer H, Woldie H. Incidence and associated factors of chronic pain after caesarean section: a systematic review. J Obstet Gynaecol Can, 2019, 41(6): 840-854.
56. Weibel S, Neubert K, Jelting Y, et al. Incidence and severity of chronic pain after caesarean section: A systematic review with meta-analysis. Eur J Anaesthesiol, 2016, 33(11): 853-865.
57. Keene DJ, Knight R, Bruce J, et al. Chronic pain with neuropathic characteristics after surgery for major trauma to the lower limb: prevalence, predictors, and association with pain severity, disability, and quality of life in the UK WHiST trial. Bone Joint J, 2021, 103-B(6): 1047-1054.

Chinese Journal of Evidence-Based Medicine

Prevalence and risk factors of chronic pain after cesarean section: a systematic review

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