Cesarean Delivery, Cesarean Section, Cesarean Section Complications, Chronic Pain, Persistent Pain, Questionnaire, SMS
Conditions
Keywords
persistent pain, chronic pain, Danish cohort, cesarean section, cesarean delivery, acute on chronic pain, post operative pain, SMS questionnaire
Brief summary
In Denmark, around 12,700 patients undergo Cesarean delivery (CD) annually, constituting approximately 20% of all childbirths in the country. Worldwide, the number is increasing each year, with more than 20 million CD performed annually. Postoperative pain after CD is typically moderate to severe in intensity and still constitutes a significant challenge, balancing effective pain relief and potential side effects. Correlations between moderate to severe acute pain and the development of persistent pain after CD is still unclear. Postsurgical persistent pain is a significant, often unrecognized clinical problem that causes distress and diminishes the quality of life for patients. Despite advances in understanding the factors contributing to persistent postsurgical pain and an increased focus on identifying patients at risk, the management and prevention of postsurgical persistent pain are still inadequate. It is important to gain further insights into this population, and we have a unique opportunity to do so by following the national cohort from the ongoing Danish multicenter cohort study on pain after cesarean section (ClinicalTrials.gov Identifier: NCT06012747) over an extended follow-up period. This involves continued prospective registration of Patient-Reported Outcome Measures (PROM) collected by SMS-based questionnaires in the months and years after the CD, thereby investigating the occurrence of both acute and persistent pain after CD. The outcomes are focused on pain levels, the impact of pain on physical function and neuropathic pain characteristics in the months and years following the CD. The study also aims to explore the relationship between persistent and acute pain.
Detailed description
The Study Protocol is attached in full-text (Study Documents).
Interventions
None listed
Sponsors
Nordsjaellands Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Inclusion criteria
* Patients who, after participating in the Danish multicenter cohort study on pain after cesarean delivery (ClinicalTrials.gov Identifier: NCT06012747), consent to continue to receive questionnaires about persistent pain. * Planned cesarean delivery in spinal anesthesia * Patients who speak and read Danish * Patients with a smartphone that can receive an SMS with a link to a questionnaire that can be opened online.
Exclusion criteria
• \<18 years of age
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Persistent pain | after 6 months | The percentage of patients reporting pain equivalent to an NRS score \> 3 after 6 months |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain/discomfort when walking on stairs. | Assessments are conducted at 5 weeks, 2, 3, 6, and 12 months, and after that every 6 months until 3 years after surgery. | 1-5: Not at all, a little, to some extent, to a great extent, cannot do due to pain. |
| Pain/discomfort during or after sexual intercourse. | Assessments are conducted at 5 weeks, 2, 3, 6, and 12 months, and after that every 6 months until 3 years after surgery. | 1-7: Not at all, a little, to some extent, to a great extent, cannot do due to pain, I don't know - I haven't tried, I prefer not to answer. |
| Pins and needles, tingling or stabbing sensations in or around the area of the surgery? | Assessments are conducted at 5 weeks, 2, 3, 6, and 12 months, and after that every 6 months until 3 years after surgery. | Yes/No |
| Electric shock like sensation or jabbing feelings in the skin area in or around the area of the surgery? | Assessments are conducted at 5 weeks, 2, 3, 6, and 12 months, and after that every 6 months until 3 years after surgery. | Yes/No |
| Heat or burning sensations in or around the area of the surgery? | Assessments are conducted at 5 weeks, 2, 3, 6, and 12 months, and after that every 6 months until 3 years after surgery. | Yes/No |
| Pain caused by the lightest of touches in or around the area of the surgery? | Assessments are conducted at 5 weeks, 2, 3, 6, and 12 months, and after that every 6 months until 3 years after surgery. | Yes/No |
| Pain caused by cold temperatures in or around the area of surgery? | Assessments are conducted at 5 weeks, 2, 3, 6, and 12 months, and after that every 6 months until 3 years after surgery. | Yes/No |
| Severe pain during the last 24 hours. | Assessments are conducted at 5 weeks, 2, 3, 6, and 12 months, and after that every 6 months until 3 years after surgery. | NRS 0-10 |
| Severe pain at rest during the last 24 hours. | Assessments are conducted at 5 weeks, 2, 3, 6, and 12 months, and after that every 6 months until 3 years after surgery. | NRS 0-10 |
| Use of analgesic medication in the past week due to pain (Paracetamol, Non-Steroidal Anti-Inflammatory Drug, opioid). | Assessments are conducted at 5 weeks, 2, 3, 6, and 12 months, and after that every 6 months until 3 years after surgery. | Yes/No |
| Pain's affect on daily activities | Assessments are conducted at 5 weeks, 2, 3, 6, and 12 months, and after that every 6 months until 3 years after surgery. | 1-5: Not at all, a little, to some extent, to a great extent, cannot do due to pain. |
| Pain's affect on engaging in strenuous physical activity. | Assessments are conducted at 5 weeks, 2, 3, 6, and 12 months, and after that every 6 months until 3 years after surgery. | 1-6: Not at all, a little, to some extent, to a great extent, cannot do due to pain, I don't know - I haven't tried. |
| Pain's affect on meeting the infant's needs. | Assessments are conducted at 5 weeks, 2, 3, 6, and 12 months, and after that every 6 months until 3 years after surgery. | 1-5: Not at all, a little, to some extent, to a great extent, cannot do due to pain. |
| Pain's affect on sleep. | Assessments are conducted at 5 weeks, 2, 3, 6, and 12 months, and after that every 6 months until 3 years after surgery. | 1-4: Not at all, a little, to some extent, to a great extent. |
| Pain's affect on mood. | Assessments are conducted at 5 weeks, 2, 3, 6, and 12 months, and after that every 6 months until 3 years after surgery. | 1-4: Not at all, a little, to some extent, to a great extent. |
| Pain/discomfort when sitting down or standing up from a chair. | Assessments are conducted at 5 weeks, 2, 3, 6, and 12 months, and after that every 6 months until 3 years after surgery. | 1-5: Not at all, a little, to some extent, to a great extent, cannot do due to pain. |
| Pain/discomfort when getting in or out of bed. | Assessments are conducted at 5 weeks, 2, 3, 6, and 12 months, and after that every 6 months until 3 years after surgery. | 1-5: Not at all, a little, to some extent, to a great extent, cannot do due to pain. |
| Pain/discomfort when carrying the infant. | Assessments are conducted at 5 weeks, 2, 3, 6, and 12 months, and after that every 6 months until 3 years after surgery. | 1-5: Not at all, a little, to some extent, to a great extent, cannot do due to pain. |
| Pain/discomfort when sitting up for less than 30 minutes. | Assessments are conducted at 5 weeks, 2, 3, 6, and 12 months, and after that every 6 months until 3 years after surgery. | 1-5: Not at all, a little, to some extent, to a great extent, cannot do due to pain. |
| Pain/discomfort if sitting up for more than 30 minutes. | Assessments are conducted at 5 weeks, 2, 3, 6, and 12 months, and after that every 6 months until 3 years after surgery. | 1-6: Not at all, a little, to some extent, to a great extent, cannot do due to pain, I don't know - I haven't tried. |
| Pain/discomfort when moving around at home. | Assessments are conducted at 5 weeks, 2, 3, 6, and 12 months, and after that every 6 months until 3 years after surgery. | 1-5: Not at all, a little, to some extent, to a great extent, cannot do due to pain. |
| Pain/discomfort if walking for more than 30 minutes. | Assessments are conducted at 5 weeks, 2, 3, 6, and 12 months, and after that every 6 months until 3 years after surgery. | 1-6: Not at all, a little, to some extent, to a great extent, cannot do due to pain, I don't know - I haven't tried. |
| Pain/discomfort when bending down. | Assessments are conducted at 5 weeks, 2, 3, 6, and 12 months, and after that every 6 months until 3 years after surgery. | 1-5: Not at all, a little, to some extent, to a great extent, cannot do due to pain. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Association between severe acute pain (NRS > 6) during the first 24 hours and the occurrence of persistent pain at 6 and 12 months after CD. | 12 months | Exploratory |
| Prevalence of chronic pain before pregnancy. | 6 months | Exploratory |
| Prevalence of chronic pain before pregnancy and its association with the development of persistent pain | 1, 2, 3, and 12 months, as well as 1,5; 2; 2,5 and 3 years after cesarean delivery. | Exploratory |
| 6. Association between uterine exteriorization versus in situ repair in CD and the occurrence of persistent pain | 1, 2, 3, and 12 months, as well as 1,5; 2; 2,5 and 3 years after cesarean delivery. | Exploratory |
| Percentage of patients experiencing pain with an NRS > 3 | 1, 2, 3, and 12 months, as well as 1,5; 2; 2,5 and 3 years after cesarean delivery. | Exploratory |
| Recall of acute pain at 12 and 24 hours after CD | Asked 12 months after CD. | Exploratory |
Countries
Denmark
Outcome results
None listed