Authors: Jethwa et al.
International Journal of Obstetric Anesthesia, 2026
Use of a Single Pain Coping Skills Session (Empowered Relief) for Outpatient Postpartum Pain Following Cesarean Delivery: A Pilot Feasibility Study
Key Points
Chronic pain after cesarean delivery affects a meaningful number of patients and can reduce quality of life.
This pilot study tested whether Empowered Relief, a single 2-hour outpatient pain coping skills session, was feasible for postpartum patients with pain after cesarean delivery.
Using a pain severity threshold of 4/10 or higher at the 6-week postpartum visit resulted in too few eligible patients.
Only 4 of 48 screened patients met the pain severity eligibility threshold, and none ultimately completed the intervention.
The study suggests that future postpartum pain intervention trials may need broader eligibility criteria, including any pain interference rather than pain severity alone.
Summary
This pilot feasibility study examined whether a single outpatient pain coping skills session, known as Empowered Relief, could be used for patients experiencing pain 6 weeks after cesarean delivery. The study was based on the concern that chronic pain after cesarean delivery affects approximately 17% of patients and can meaningfully affect recovery, function, and quality of life.
The intervention was designed as a 2-hour behavioral pain skills session delivered by an instructor in the outpatient setting. Patients were screened at their 6-week postpartum clinic visit using qualitative questions and 0-to-10 numeric rating scales for pain severity and pain interference. Patients with moderate to severe pain, defined as a pain severity score of 4/10 or higher, were eligible for enrollment and randomization to either Empowered Relief or standard follow-up care.
The primary outcome was feasibility. Secondary outcomes included changes in pain interference, pain severity, and pain catastrophizing at 12 weeks postpartum. However, the study was unable to meaningfully evaluate those outcomes because too few patients met the eligibility criteria and no patients completed the intervention.
Between July and November 2025, 48 patients were assessed for pain severity. Only 4 patients, or 8%, reported pain of 4/10 or higher and were considered eligible. The remaining 44 patients, or 92%, were ineligible under the study’s pain severity threshold. Of the 4 eligible patients, 3 declined participation because of the time commitment, and 1 consented but did not attend the Empowered Relief session. The trial was stopped because of the low eligibility rate and inability to deliver the intervention.
An important finding was that pain interference was more common than moderate-to-severe pain intensity. Pain interference greater than 0/10 was reported by 59% of patients. Median pain severity was 0, while median pain interference was 1. This suggests that many postpartum patients may experience some degree of functional impact from pain even when they do not report pain intensity high enough to meet a 4/10 threshold.
Another notable finding was that in 88% of cases, patients reported higher pain scores to the research team than they had reported to the clinical team. This raises an important point for postpartum care: routine clinical encounters may under-detect ongoing pain unless pain and functional interference are assessed specifically and consistently.
The authors concluded that using a pain severity threshold of 4/10 or higher at the 6-week postpartum visit did not identify enough eligible patients to evaluate the Empowered Relief intervention. Future studies may need to use broader criteria, such as any pain interference or a combination of pain severity and interference, to better identify patients who may benefit from outpatient postpartum pain interventions.
What You Should Know
This study did not show whether Empowered Relief works for postpartum pain after cesarean delivery because the trial could not enroll and treat enough patients. However, it provides an important lesson about study design and postpartum pain screening.
For anesthesia and obstetric teams, the key message is that pain intensity alone may not be the best way to identify patients who need help after cesarean delivery. A patient may report low pain severity but still experience pain-related interference with daily activities, infant care, sleep, mobility, or quality of life.
The study also suggests that postpartum pain may be underreported in routine clinical settings. Asking more specific questions about pain interference may help clinicians identify patients who are struggling even when their pain score does not appear high.
Overall, this pilot study supports the need for better screening strategies in postpartum pain research. Future trials should consider eligibility criteria based on pain interference, any persistent pain, or a combination of severity and functional impact rather than relying only on a numeric pain severity threshold.
Thank you to the International Journal of Obstetric Anesthesia for allowing us to summarize and share this article.