Association of Pain Catastrophizing and Depressive States with Multidimensional Early Labor Pain Assessment in Nulliparous Women Having Epidural Analgesia-A Secondary Analysis

Background: Labor pain is a variable and complex experience with both sensory and affective components. Pain catastrophizing tendencies are predictive of increased distress during labor. Likewise, pain severity has important associations with increased depressive symptoms in mothers, with consequences on perinatal and infant outcomes. Hence, we investigated the association between increased early labor pain with both pre-delivery pain catastrophizing and depressive states. Methods: We recruited nulliparous women who had requested labor epidural analgesia. Pre delivery questionnaires including short-form McGill pain questionnaire-2 (SF-MPQ-2), pain catastrophizing scale (PCS), and Edinburgh postnatal depression score (EPDS) were administered. Results: A total of 712 women completed the pre-delivery questionnaires. There was a significant association between SF-MPQ-2 neuropathic subscale and EPDS > 10 (unadjusted OR 1.74, 95% CI 1.11-2.73, p = 0.0161), as well as PCS > 25 (unadjusted OR 1.55, 95% CI 1.06-2.26, p = 0.0244). SF-MPQ-2 sensory intermittent subscale and EPDS > 10 (unadjusted OR 2.02, 95% CI 1.34-3.03, p = 0.0007), and PCS > 25 (unadjusted OR 1.59, 95% CI 1.14-2.23, p = 0.0069) also showed significant association. Conclusion: Increased sensory intermittent and neuropathic subsets of early labor pain are significantly correlated with increased pre-delivery pain catastrophizing and depressive states in nulliparous women. This positive association may be useful for pre-delivery risk stratification for early interventions towards a more holistic care management.