Effect of Preoperative Pain Catastrophizing on Postpartum Depression and Chronic Postsurgical Pain After Cesarean Section: A Prospective Cohort Study

Yunhong Ren,1, Lulu Cao,2, Yinhao Guo,1 Suihan Xu,1 Baoxia Sun,1 Ling He,1 Juan Du,1 Jun Li1 1Mianyang Key Laboratory of Anesthesia and Neuroregulation, Department of Anesthesiology, Mianyang Central Hospital, Mianyang, People’s Republic of China; 2Department of Nuclear Medicine, Mianyang Central Hospital, Mianyang Central Hospital, Mianyang, People’s Republic of ChinaThese authors contributed equally to this workCorrespondence: Jun Li, Mianyang Key Laboratory of Anesthesia and Neuroregulation, Department of Anesthesiology, Mianyang Central Hospital, Mianyang, Sichuan, People’s Republic of China, Email lj89199@163.com Juan Du, Email 1151941061@qq.comObjective: We aimed to analyze the effects of pain catastrophizing on Chronic postsurgical pain(CPSP) and postpartum depression(PPD) in cesarean section(CS).Methods: Women who underwent CS at our hospital between January 15th 2023 and August 15th 2023 were included. Pain catastrophizing was assessed before the surgery. The outcomes were the incidence of CPSP and PPD at 3, 6 and 12 months postoperatively. Bivariate logistic regression was used to identify risk factors for CPSP and PPD. Confounding factors were adjusted to determine the association between preoperative pain catastrophizing and CPSP and PPD.Results: A total of 658 women were followed up after CS. The incidence of CPSP at 3, 6 and 12 months postoperatively were 18.8% (124/658), 9.3% (61/658) and 3.5% (23/658), respectively. The incidence of PPD at 3, 6 and 12 months were 14.0% (92/658), 6.8% (45/658) and 5.9% (39/658), respectively. Univariate analysis revealed significant differences between the CPSP and no-CPSP groups, as well as the PPD and no-PPD groups, in terms of BMI incision length, intraoperative hemorrhage, inadequate analgesia, and pain catastrophizing at 3, 6, and 12 months postoperatively (P< 0.05). Spearman correlation analysis showed that pain catastrophizing was correlated with CPSP at 3, 6, 12 months and PPD at 3 months (P< 0.05). Binary logistic regression analysis showed that, after controlling for confounding variables, pain catastrophizing was associated with an increased risk of CPSP at 3 months (odds ratio OR=2.501, 95% confidence interval CI=1.265‒4.926) and PPD at 3 months (OR=2.144, 95% CI=1.116‒4.117), but not CPSP (OR=0.645, 95% CI=0.265– 1.568) and PPD at 6 months (OR=0.531, 95% CI=0.249– 1.131) or CPSP (OR=0.818, 95% CI=0.959– 1.501) and PPD (OR=0.979, 95% CI=0.936– 1.024) at 12 months after surgery.Conclusion: Although the long-term effects of pain catastrophizing require further research, medical professionals still need to conduct brief psychoeducation in the preoperative period, conducting routine PCS screening to identify high-risk patients to reduce the incidence of CPSP and PPD after CS.Keywords: cesarean section, chronic postsurgical pain, postpartum depression, pain catastrophizing