A study presented at ANESTHESIOLOGY 2011 in Chicago is perhaps the first to evaluate pain associated with surgical incisions or scars before repeat cesarean (CS) procedures, and the data could lead to improved care for a rapidly growing and unique group of patients.
According to lead researcher Ruth Landau, M.D., from the University of Washington, Seattle, 1.4 million cesareans are performed annually in the U.S., of which 30 percent are repeat procedures.
Despite the frequency of such procedures, post-CS pain remains undertreated and is associated with scar sensitivity and persistent pain.
"Interestingly, we found that less than 10 percent of women recalled having persistent pain after the previous CS delivery, but scar hypersensitivity was found in 40 percent of women," said Dr. Landau. "Furthermore, women with abnormal preoperative scar mapping had higher pain scores during the two days after delivery, and the extent of scar sensitivity correlated with pain severity and postoperative pain sensitivity."
"Scar mapping" is a procedure using pin-prick stimulation of a scar or wound to determine sensitivity to pain.
In Dr. Landau's study, 163 women scheduled for a repeat CS delivery were evaluated for pain sensitivity through scar mapping and several questionnaires used to determine their pain status and psychosocial parameters.
This combination of tests substantiated the hypothesis of Dr. Landau's research team that a high percentage of woman undergoing repeat CS deliveries are suffering from abnormal sensitivity to pain.
Dr. Landau said that scar mapping could allow physicians to predict which women are at higher risk for persistent pain and could help in determining a drug regimen that would control such pain.
"The fact that pain testing easily performed in a clinical setting may help identify patients with deficient pain modulation is exciting," said Dr. Landau. "Identifying women at risk for pain offers avenues to prevent unnecessary suffering at a time that should otherwise be a joyful and uncomplicated event."
American Society of Anesthesiologists