Pain Severity and Pain Interference in Late Pregnancy: An Analysis of Biopsychosocial Factors among Women Scheduled for Cesarean Delivery.

OBJECTIVE: Pain is a variably experienced symptom during pregnancy, and women scheduled for cesarean delivery, an increasingly common procedure, are a relatively understudied group who may be at higher pain risk. While biopsychosocial factors are known to modulate many types of chronic pain, their contribution to late pregnancy pain has not been comprehensively studied. We aimed to identify biopsychosocial factors associated with greater pain severity and interference during the last week of pregnancy.

METHODS: In this prospective, observational study, 662 pregnant women scheduled for cesarean delivery provided demographic and clinical information, and completed validated psychological and pain assessments. Multivariable hierarchical linear regressions assessed independent associations of demographic, clinical, and psychological characteristics with pain severity and pain interference during the last week of pregnancy.

RESULTS: Women had a mean age of 34 years, 73% identified as White, 11% as African American, 10% as Hispanic/Latino, and 6% as Asian. Most women (66%) were scheduled for repeat cesarean delivery. Significant independent predictors of worse pain outcomes included identifying as African American or Hispanic/Latino and greater depression, sleep disturbance, and pain catastrophizing. Exploratory analyses showed that women scheduled for primary (vs. repeat) cesarean delivery reported higher levels of anxiety and pain catastrophizing.

CONCLUSIONS: Independent of demographic or clinical factors, psychological factors including depression, sleep disturbance, and pain catastrophizing conferred greater risk of late pregnancy pain. These findings suggest that women at higher risk of pain during late pregnancy may benefit from earlier nonpharmacological interventions that concurrently focus on psychological and pain symptoms.