Kristin Schreiber, MD, PhD

Pronouns

She/Her/Hers

Rank

Associate Professor

Institution

BWH

BWH-MGH Title

Associate Professor

Department

Anesthesia

Authors

Demario S. Overstreet, Ph.D., Jenna M. Wilson, Ph.D., Annabella J. He., RDN., LDN., Mikayla K. Flowers, BS. Carin A. Colebaugh B.S., Mieke A. Soens, M.D., Kristin L. Schreiber M.D., Ph.D

Racial Differences in Pain Experiences Prior to Cesarean Delivery

WMSS 2022

My research program investigates the development of chronic pain after surgical injury, using psychosocial and psychophysical assessment tools, in addition to biomarkers, clinical characteristics, and socio-demographics, to predict who is most at risk. Our perioperative interventional studies incorporate this dense biopsychosocial assessment of individual patients into their design, to allow more nuanced assessment of differential efficacy of preventive perioperative interventions among patients, in order to ultimately inform more personalized care. We recently found these differences in the pain experience among women coming for C-section, which underscore the importance of understanding contributors to racial and ethnic differences in the pain experience.

Background

Interindividual variability in pain intensity and burden creates an appreciable clinical challenge to treating pain with a standard protocol. Many factors under the biopsychosocial model, including race, may help explain this variability, and aid in identifying individuals who are at risk for worse pain and pain undertreatment. Previous research suggests that African American and Hispanic patients are disproportionately burdened by chronic pain (Meints 2019). Pregnant women are often excluded from pain studies, although some studies have found racial differences in pain after surgical procedures including cesarean delivery (C-section) (Johnson 2019). Very little research has been conducted to understand whether race may account for some of the variability in pain experienced by pregnant women, either during pregnancy, or in the perinatal period. We investigated racial differences in self-reported average pain and pain interference during the last week of pregnancy, and procedural pain during the placement of spinal anesthesia.

Methods

Women (N=613; M_age= 34 years, SD=4.5, range=21-52) scheduled to undergo a c-section self-reported their race and completed the Brief Pain Inventory to assess clinical pain severity and pain interference over the past week leading up to their c-section. After receiving the injection of a local anesthetic, women reported on their pain at the local site (0-10). For most women (67%), this was a repeat c-section. Women self-identified as African American (n=65, 11%), White (n =453, 74%), Asian (n=33, 5%) or Hispanic/Latino (n=62, 10%). Three Analyses of Variance (ANOVAs) were used to investigate racial differences in pain outcomes.

Results

There were statistically significant racial differences in pain severity [F(3,609) = 7.07, p < .001, partial η² = .03], pain interference [F(3,609) = 7.07, p < .001, partial η² = .02], and acute pain ratings following the injection of a local anesthetic [F(3,609) = 7.07, p < .001, partial η² = 03]. Post-hoc analyses, Fisher’s LSD, revealed that women who identified as African American or Hispanic/Latina reported significantly greater pain across all three outcomes compared to women who identified as White or Asian, all p < .001. There were no significant differences in pain outcomes between African American and Hispanic/Latino women, nor between White and Asian women.

Conclusion

Prior studies have concluded that racial minorities, African American and Hispanic women, experience more pain following cesarean delivery than their counterparts who identify as either Asian or Non-Hispanic White. Additionally, our findings suggests that women who are racial minorities might also present with greater pain immediately prior/ leading into cesarean delivery. Future studies should investigate possible preoperative interventions that could potentially reduce acute/chronic pain following c section. More research is also needed to determine whether these prenatal findings are associated with postoperative acute and chronic pain.