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Abstract
The number of Caesarean section (CS) procedures has increased dramatically both in
developed and developing countries in recent decades. CS has been associated with
chronic pain. A vicious impediment on quality of life may occur among women who experience
chronic post-CS pain (CPCSP). Therefore, this systematic review aimed to synthesize
the available evidence on the incidence of chronic pain after Caesarean delivery and
the possible risk factors for the development of chronic pain. The PubMed, Embase,
and Google Scholar databases were searched for articles published in English between
2004 and January 2017 using appropriate terms. Studies that examined the incidence
of chronic pain after CS as their primary outcome measure, and follow-up period of
more than 2 months was selected. Both authors searched and reviewed the studies for
eligibility and extracted the data in predefined forms. We also conducted a hand search
of the reference lists of included articles. Findings from the reviewed studies are
summarized using narrative and tables. Of the 4932 records, 17 studies met the review
eligibility criteria. This review found that the incidence of CPCSP varies among studies
and is influenced by preoperative patient factors and surgical- and anaesthetic-related
factors. Of the reviewed studies, the majority were examined for chronic pain at 3
months after CS. The incidence of CPCSP after 2 to less than 6 months was found to
range between 4% and 41.8%. The reported factors that influence CPCSP were inconsistent
among studies. Despite this, the presence of a higher intensity of pain on postoperative
day 1 was the most commonly identified factor associated with CPCSP. This systematic
review found a clinically important incidence of CPCSP, ranging from 4% to 41.8% at
2 to less than 6 months after CS. Moreover, the evidence demonstrates that severe
acute postoperative pain after CS is an important contributing factor for the development
of CPCSP. However, no strong evidence-based conclusions and recommendations may be
drawn from the evidence. Future well-designed studies with a longer follow-up period
are needed to identify the most important perioperative factors associated with chronic
pain following Caesarean delivery.