Examining Disparities in the Evaluation and Management of Cesarean Birth Pain Among Patients With and Without a Psychiatric Condition

Background Postoperative pain management is an important aspect of postpartum care following cesarean delivery (CD). This study aimed to determine whether differences exist in pain assessments and opioid administration after CD between patients with psychiatric illness and those without. Methodology This was a retrospective cohort study of 490 patients who underwent CD at an urban tertiary care center. Demographic and delivery data were collected by chart review. The primary outcomes were the number of pain assessments performed, average pain score, and amount of morphine milligram equivalents (MMEs) administered to patients with and without psychiatric illness. Results A total of 389 patients without a psychiatric diagnosis were compared to 101 patients with a psychiatric diagnosis. After adjusting for baseline characteristics in all models, psychiatric history had a significant effect on pain severity (β = 0.25; 95% confidence interval (CI) (0.00, 0.49); p = 0.046) and number of pain assessments (β = -2.41; 95% CI (-4.42, -0.41); p = 0.018), but not on MME administration (incidence rate ratio = 1.31; 95% CI (0.60, 2.92); p = 0.466). Patients with a psychiatric history reported more severe pain after CD and received fewer pain assessments. There was no significant difference in the amount of pain medication administered between groups. Conclusions In this study, patients with a psychiatric diagnosis received fewer pain assessments and reported more severe post-CD pain compared to those without. Despite this difference, both groups received similar amounts of pain medication, raising concern for bias and inadequate treatment of pain in patients with a psychiatric diagnosis.