Fatores associados à catastrofização da dor aguda pós-cesária e seus impactos na recuperação funcional de puérperas em pós-operatório mediato: um estudo transversal

Abstract

Introduction: Cesarean section is one of the most commonly performed surgical procedures among women of reproductive age, and acute postoperative pain is one of its most frequent complications. Acute post-cesarean pain represents a major challenge to postpartum recovery. Pain catastrophizing, characterized by a negative cognitive and emotional response to actual or anticipated pain, has been associated with greater pain intensity and impaired functional recovery. Objective: To evaluate the factors associated with acute post-cesarean pain catastrophizing and its impact on the functional recovery of women during the early postoperative postpartum period. Method: This was a cross-sectional analytical study conducted in a low-risk maternity hospital in the interior of Sergipe, Northeastern Brazil. Puerperal women in the intermediate postoperative period (≥24 h) after cesarean section were included. The primary outcome was pain catastrophizing, assessed using the 13-item Pain Catastrophizing Scale (PCS), which measures catastrophic thinking related to pain using a 5- point Likert scale. Independent variables included pain characteristics, sociodemographic, clinical, obstetric, and perioperative factors. Descriptive statistics were presented as absolute and relative frequencies. Bivariate associations were tested using Pearson’s chi-square or Fisher’s exact test, with Cramér’s V estimation. Correlations between catastrophizing and functional outcomes were assessed using Pearson’s correlation coefficient with bootstrap resampling (1,000 samples) and BCa 95% confidence intervals. The overall impact of catastrophizing on functionality was analyzed using multivariate analysis of covariance (MANCOVA), adjusted for pain intensity. Multivariate significance was evaluated using Pillai’s trace. Following a significant global effect, ANCOVAs were performed for each functional outcome, with bootstrap adjustment and Bonferroni correction. Results were expressed as estimated marginal means and effect sizes (partial eta squared, η²p), adopting a 5% significance level. Results: The sample comprised 232 puerperal women experiencing pain in the intermediate postoperative period following cesarean section, with a predominance of moderate to severe pain at the time of interview (52.6%). Most participants were younger than 35 years (79.3%), self-identified as non-White (88.8%), were users of the public health system (78.4%), unemployed (79.7%), recipients of governmental financial assistance (59.9%), and lived in owned housing (68.1%) in urban areas (56.9%). Educational level was predominantly ≥12 years of schooling (59.1%). Pain catastrophizing was correlated with functional impairments. Multivariate analysis (MANCOVA) demonstrated a significant effect of catastrophizing on functional outcomes (Pillai’s trace = 0.49; F(34,426) = 4.110; p < 0.001; ηp2 = 0.247). In the univariate analyses adjusted for pain intensity (ANCOVA), catastrophizing significantly impacted 15 of the 17 functional outcomes assessed (p < 0.05). Post hoc multiple comparisons showed that women with low levels of catastrophizing had significantly better functionality than those with high/very high levels across most outcomes, with pronounced mean differences in general activity (Mdiff = −3.36; p < 0.001), mood (Mdiff = −3.59; p < 0.001), and breastfeeding (Mdiff = −3.20; p = 0.002). Significant differences were also observed between the low and moderate catastrophizing groups, particularly regarding ambulation (p < 0.001) and newborn care activities, such as bathing (p = 0.010) and holding the infant (p = 0.013). Conclusion:Pain catastrophizing was associated with pain and functionality in the postoperative period following cesarean section. Associations were observed with gynecological-obstetric characteristics, childbirth care, and pain-related factors. A previous history of postpartum depression and labor induction increased the likelihood of elevated levels of this construct, independently of age and pain intensity. Catastrophizing significantly impacted functional outcomes, with greater impairments among women with higher levels of catastrophizing.