Analgesia after Labor and Cesarean Section: Chronic Pain after Pregnancy

Chronic pain (CP) conditions after childbirth include persistent pain after caesarean section (CPCS), perineal pain after instrumental vaginal delivery, lower back pain and pelvic girdle pain. Any type of CP before or during pregnancy increases the risk of CP after delivery. Scar pain is the most recognized etiology for CPCS with a neuropathic component, although it is less frequent than in other surgeries. Reported CPCS incidence ranges from 1 to 23%. Pain intensity is moderate and decreases with time in all studies. The severity and duration of peripartum pain are the main risk factors for CP and its control is the most recommended strategy for reducing risk. Fear of fetal and neonatal adverse events means that CP is often undertreated, but after delivery, pharmacological restrictions disappear and many pain drugs are compatible with breastfeeding. Education of obstetric teams about early detection and referral to specialized consultation of women with CP is the key. In this chapter, available information in the recent literature, mainly during the last years, is presented. This chapter focuses on CP conditions after childbirth, as analgesia for labor and childbirth and immediate pain after CS and vaginal delivery are covered in other chapters of this book.