Brief Assessment of Patient Phenotype to Explain Variability in Postsurgical Pain and Opioid Consumption after Cesarean Delivery

Understanding factors that explain why some women experience greater postoperative pain and consume more opioids after cesarean delivery (CD) is crucial to building an evidence base for personalized prevention. Comprehensive psychosocial assessment with validated questionnaires in the preoperative period can be time-consuming. A 3-item questionnaire has shown promise as a simpler tool to be integrated into clinical practice, but its brevity may limit the ability to explain heterogeneity in psychosocial pain modulators among individuals. We compared the explanatory ability of 3 models: (1) the 3-item questionnaire, (2) a 58-item questionnaire (Long) including validated questionnaires (e.g., BPI, PROMIS) plus the 3-item questionnaire, and (3) a novel 19-item questionnaire (Brief) assessing several psychosocial factors plus the 3-item questionnaire. Additionally, we explored the utility of adding a pragmatic quantitative sensory test (QST) to models.

In this prospective, observational study, 545 women undergoing CD completed questionnaires pre-surgery. Pain during local anesthetic skin wheal prior to spinal placement served as a pragmatic QST. Postoperatively, pain and opioid consumption were assessed. Linear regression analysis assessed model fit and the association of model items with pain and opioid consumption during the 48 hours following surgery.

A modest amount of variability was explained by each of the 3 models for postoperative pain and opioid consumption. Both Brief and Long questionnaire models performed better than the 3-item questionnaire, but were themselves statistically indistinguishable. Items that were independently associated with pain and opioid consumption included anticipated postsurgical pain medication requirement, surgical anxiety, poor sleep, pre-existing pain, and catastrophic thinking about pain. QST was itself independently associated with pain across models, but only modestly improved models for postoperative pain.

The Brief questionnaire may be more clinically feasible than longer validated questionnaires, while still performing better and integrating a more comprehensive psychosocial assessment than the 3-item questionnaire.