Examine the predictive association of pain intensity at 1 month postpartum over pain intensity at 12 months postpartum and the mediating roles of pain catastrophizing at 3 months postpartum, as well as depressive symptoms and pain interference at 6 months postpartum.
A total of 504 women (M=31.2, SD=5.3 years old) from different health care centers at Santiago (Chile) completed measures of pain intensity, pain catastrophizing, depressive symptoms, and pain interference at 1, 3, 6, and 12 months postpartum. As an exclusion criterion, none of the participants had chronic pain before pregnancy. The model was estimated using Structural Equation Model, with all four variables of interest modeled as latent variables. Pain catastrophizing was estimated as a second-order variable, using its three dimensions (magnification, rumination, and helplessness) as first-order factors.
The structural model had an acceptable fit to the data (χ2(653)=1392.43, p.001; CFI=0.92; TLI=0.92; RMSEA= 0.06; SRMR=0.05). Pain intensity at 1 month postpartum predicted pain catastrophizing at 3 months (b=0.17, p.001), depressive symptoms (b=0.06, p=.003) and pain interference (b=0.37, p=.001) at 6 months and pain intensity at 12 months (b=0.20, p=.002). Pain catastrophizing at 3 months also explained part of the variance of depressive symptoms (b=0.17, p.001) and pain interference (b=0.88, p.001) at 6 months. Pain interference at 6 months postpartum predicted pain intensity at 12 month (b=0.21, p.001) but depression did not (b=-0.83, p=.69). Finally, pain catastrophizing at 3 months presented an indirect effect over pain intensity at 12 months, through its effect over pain interference (b=0.18, p=.007). The model explained 7% of the variance of pain catastrophizing at 3 months, 16% of the variance of depressive symptoms and pain interference at 6 months, and 17% of the variance of pain intensity at 12 months postpartum.
The results of the present study partially supported the association proposed on the Fear-Avoidance Model in the context of the postpartum period, indicating that initial pain intensity predicts late pain intensity, and this association is mediated by pain catastrophizing and pain interference. These results highlight the importance of promoting adequate pain management in women in their first postpartum month. Additionally, they suggest that evaluating and intervening in the levels of pain catastrophizing and interference may be helpful to reduce pain intensity in the long term.
These results suggest that adequate pain management in women at their early postpartum stage, as well as decreasing their levels of pain catastrophizing and pain interference, could be helpful to reduce their pain intensity in the long term.
Catastrophizing
Postpartum
