Persistent post-partum pain after vaginal birth and cesarean section

Purpose of review: Labor pain remains under evaluated and under managed while evidence is growing that post partum treatments strongly influence patients' outcome. The present review examines the recent developments in mechanisms underlying labor and delivery pain and questions current understanding of post-partum pain features observed in patients. Recent findings: Different strategies to approach acute labor pain have been developed. Chronic pain after labor and delivery has not been studied so extensively. Prevalence rates of chronic pain after cesarean section are between 6 and 18% and after vaginal delivery they are between 4 and 10%. Predictors for chronic pain after cesarean section and delivery are previous chronic pain, general anesthesia and higher post delivery pain. As labor pain is rated as one of the most serious kinds of acute pain we speculate that effective treatment of this pain with peripartum epidural analgesia could prevent the development of chronic pain. Conclusion: Treatment of acute pain during labor and delivery is necessary to prevent chronic pain. Effective perioperative block of nociceptive inputs from the wound as well as use of antihyperalgesic and analgesic drugs in combination seem the best way to control postoperative pain and specifically, to prevent central sensitization. Future studies should focus on the long-term effects of different analgesic regimens on the development of chronic pain after labor and delivery.