# Childhood sexual abuse and post-cesarean pain

## TL;DR

Women who experienced childhood sexual abuse report higher pain and opioid use after cesarean surgery, even without a history of chronic pain.

## Contribution

This study identifies a novel link between childhood sexual abuse and increased post-cesarean pain and opioid use in the absence of chronic pain history.

## Key findings

- Women with prepubertal sexual abuse had higher moderate-to-severe pain scores 7 days after cesarean discharge.
- They also used more opioids in the 24 hours before discharge and had more opioid prescriptions afterward.
- These associations persisted through 6 weeks postpartum but not at 90 days.

## Abstract

Sexual abuse before the age of 10 is reported by 2.7% of US women. Chronic pain has been linked to sexual abuse, but little is known about acute postoperative pain in those with a sexual abuse history and no history of chronic pain. We hypothesized that those who report prepubertal sexual abuse experience more pain at 7 days after hospital discharge from a cesarean delivery.

To evaluate whether patients who report prepubertal sexual abuse experience more pain 7 days after hospital discharge from a cesarean delivery.

Secondary analysis of a multicenter randomized trial of individuals who underwent cesarean at 31 US hospitals (2020–2022). Participants were excluded if they had chronic pain or were missing sexual abuse data. The primary outcome was moderate-to-severe worst pain (≥4 on a scale from 0 to 10), as assessed by the Brief Pain Inventory (BPI), 7 days after discharge. Secondary outcomes included BPI at 2 weeks post-discharge and 6 weeks and 90 days postpartum, Pain Catastrophizing Scale (PCS) and Physical Function (PF) scores at 6 weeks, Milligram Morphine Equivalents (MME) use in 24 h before discharge, and opioid use measured at 90 days (number of prescriptions beyond discharge and total number of tablets taken after discharge). Maternal characteristics were compared between those with and without prepubertal sexual abuse. Multivariable modeling was performed adjusting for prepregnancy body mass index (BMI), family history of substance use disorders, and Edinburgh depression score ≥13 at randomization.

Of the 4881 participants included in the analysis, 5.3% reported prepubertal sexual abuse. They were significantly more likely to have a BMI ≥30 (54% vs. 44%), a family history of substance use disorders (58% vs. 24%), and an Edinburgh depression score ≥ 13 (9% vs. 4%) (all p < 0.05). Multivariable models showed that a BPI score ≥ 4 was significantly higher 7 days post-discharge (75% vs. 57%; adjusted relative risk [aRR], 1.3 [1.2, 1.4]) in those reporting prepubertal sexual abuse. BPI scores remained significantly higher through 6 weeks (2 weeks: 42% vs. 30%; aRR, 1.3 [1.1, 1.6]; 6 weeks: 14% vs. 10%; aRR, 1.5 [1.01, 2.1]; 90 days: 5% vs. 5%; aRR, 0.9 [0.4, 1.8]). PCS score ≥ 12 (15% vs. 12%) and PF score below average (64% vs. 56%) were not significantly different at 6 weeks. Opioid use in the 24 h before discharge (median MME 22.5% vs. 15, p < 0.01), additional opioid prescriptions after discharge (10% vs. 6%; aRR, 1.7 [1.1, 2.5]), and median total opioid tabs used after discharge (9% vs. 4 tabs, p < 0.01) were all significantly higher among individuals reporting prepubertal sexual abuse.

In postpartum individuals who reported prepubertal sexual abuse, post-cesarean pain through 6 weeks and prescription opioid use were significantly higher. These associations warrant further study.