Postpartum pain associated with anxiety severity
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SAN DIEGO — Parturients with more severe postpartum pain experienced more severe anxiety, according to a small study presented here.
“The relationship between pain and anxiety in medical and surgical contexts is established; less is known about this relationship in obstetric populations,” Clara Olson, BS, a student at the University of Wisconsin School of Medicine and Public Health, and colleagues wrote. “This study evaluated whether there is an association between postpartum pain and anxiety.”
Olson and colleagues surveyed 64 patients admitted for delivery between May 24 and July 30, 2021, to Meriter Hospital in Madison, Wisconsin, using the seven-item General Anxiety Disorder (GAD-7) questionnaire and the American Pain Society-Patient Outcome Questionnaire (APS-POQ). Both questionnaires were emailed to participants on the day of discharge, and the GAD-7 was sent again 6 weeks postpartum.
Correlation between anxiety, pain
Compared with parturients without anxiety, those with GAD-7 scores indicating moderate to severe anxiety had higher maximum pain scores during the first and second days after delivery (P = .049 and P = .01, respectively). They also were more likely to have spent more time in severe pain during both periods (P = .007 and P = .01, respectively).
Patients with anxiety at discharge had significant trouble with doing activities and falling and staying asleep compared with patients who did not have anxiety.
Of note, patients with preexisting anxiety did not perceive postpartum pain management as insufficient more often than those without preexisting anxiety. Also, parturients who dealt with neonatal health concerns or NICU admissions did not have higher rates of anxiety.
“Consideration of the relationship between pain control and anxiety may help optimize patients’ postpartum experience,” Olson and colleagues wrote.
Perspective
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Postpartum depression is a common problem among delivering women, occurring in up to one in seven deliveries. While baby blues are common, these symptoms are transient, resolving after a few weeks. There is an increasing focus on postpartum depression, but some patients will have symptoms of anxiety (poor sleep, irritability, agitation, etc.) without symptoms of depression. It is important to differentiate between these diagnoses, as the treatments may vary, and patients with anxiety without depression may not respond to the same treatments as those with depression and anxiety or depression alone.
This study examines a unique source of postpartum anxiety: pain control post-delivery. Prior studies support the relationship between poor medical and surgical pain control and anxiety. Additionally, there are data demonstrating that labor pain is associated with the perception of a traumatic birth experience and may lead to anxiety. However, there are few studies examining the relationship between post-delivery pain control and postpartum anxiety.
Their study shows an increase in anxiety symptoms in patients who had more severe pain levels on days 1 and 2 post-delivery and overall more consistent severe pain levels during their recovery period. This suggests that poor pain control during the postpartum period may increase rates of postpartum anxiety. Additionally, patients with preexisting anxiety were not shown to have increased levels of perceived poor pain control. This is an interesting finding, which further supports that the perceived poor pain control is related to development of postpartum anxiety symptoms and not due to a preexisting condition.
This study provides a novel perspective on risk factors for development of postpartum anxiety and an opportunity for intervention to potentially decrease this risk. The findings of the study suggest that optimization of pain control in the postpartum period may decrease the likelihood of perceived poor pain control, and thus lower risk of the development of postpartum anxiety related to traumatic birth experience.
While it is important to consider the ongoing opioid epidemic and judicious administration of narcotics for pain control, it is also crucial to provide adequate pain control for patients in the recovery period. This study further elucidates the importance of this and the potential relationship between pain and postpartum mood disorders.
There is a need to expand this study further into the postpartum period to determine the duration of these symptoms and the percentage of patients requiring treatment for postpartum anxiety to fully understand the implications of the findings.
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Olson C, et al. Abstract 150. Presented at: ACOG Annual Clinical & Scientific Meeting; May 6-8, 2022; San Diego.
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