TY - JOUR
T1 - The influence of women's attachment style on the chronobiology of labour pain, analgesic consumption and pharmacological effect
AU - Costa-Martins, José Manuel
AU - Pereira, Marco
AU - Martins, Henriqueta
AU - Moura-Ramos, Mariana
AU - Coelho, Rui
AU - Tavares, Jorge
PY - 2014/7
Y1 - 2014/7
N2 - Circadian variation in biological rhythms has been identified as affecting both labour pain and the pharmacological properties of analgesics. In the context of pain, there is also a growing body of evidence suggesting the importance of adult attachment. The purpose of this study was to examine whether labour pain, analgesic consumption and pharmacological effect are significantly affected by the time of day and to analyse whether this circadian variation is influenced by women's attachment style. This prospective observational study included a sample of 81 pregnant women receiving patient-controlled epidural analgesia (PCEA). Attachment was assessed with the Adult Attachment Scale-Revised. The perceived intensity of labour pain in the early stage of labour (3cm of cervical dilatation and before the administration of PCEA) was measured using a visual analogue scale (VAS). Pain was also indirectly assessed by measuring the consumption of anaesthetics. The latency period and the duration of effect were recorded for a chronopharmacology characterisation. Pain, as assessed with the VAS, was significantly higher in the night-time group than in the daytime group. An insecure attachment style was significantly associated with greater labour pain at 3cm of cervical dilatation (p<0.001) and before the beginning of analgesia (p<0.001) as well as with higher analgesic consumption and lower pharmacological efficacy (p<0.05). The time of day was significantly associated with the pharmacological effect: the latency period was longer at night, and the duration of the pharmacological effect was longer during the daytime. The interaction between time of day and attachment style was not significant for any of the study variables. Our results provide evidence of the importance of circadian variation in studying labour pain and the pharmacological effect of labour analgesia involving epidural blockage with a PCEA regimen. Moreover, although there was no evidence that attachment style influenced the circadian variation, these data emphasise that insecure attachment patterns are a risk factor for greater labour pain and analgesic consumption, which should be considered in pain management approaches.
AB - Circadian variation in biological rhythms has been identified as affecting both labour pain and the pharmacological properties of analgesics. In the context of pain, there is also a growing body of evidence suggesting the importance of adult attachment. The purpose of this study was to examine whether labour pain, analgesic consumption and pharmacological effect are significantly affected by the time of day and to analyse whether this circadian variation is influenced by women's attachment style. This prospective observational study included a sample of 81 pregnant women receiving patient-controlled epidural analgesia (PCEA). Attachment was assessed with the Adult Attachment Scale-Revised. The perceived intensity of labour pain in the early stage of labour (3cm of cervical dilatation and before the administration of PCEA) was measured using a visual analogue scale (VAS). Pain was also indirectly assessed by measuring the consumption of anaesthetics. The latency period and the duration of effect were recorded for a chronopharmacology characterisation. Pain, as assessed with the VAS, was significantly higher in the night-time group than in the daytime group. An insecure attachment style was significantly associated with greater labour pain at 3cm of cervical dilatation (p<0.001) and before the beginning of analgesia (p<0.001) as well as with higher analgesic consumption and lower pharmacological efficacy (p<0.05). The time of day was significantly associated with the pharmacological effect: the latency period was longer at night, and the duration of the pharmacological effect was longer during the daytime. The interaction between time of day and attachment style was not significant for any of the study variables. Our results provide evidence of the importance of circadian variation in studying labour pain and the pharmacological effect of labour analgesia involving epidural blockage with a PCEA regimen. Moreover, although there was no evidence that attachment style influenced the circadian variation, these data emphasise that insecure attachment patterns are a risk factor for greater labour pain and analgesic consumption, which should be considered in pain management approaches.
KW - Adult attachment
KW - Chronobiology
KW - Labour pain
KW - Patient-controlled epidural analgesia
UR - http://www.scopus.com/inward/record.url?scp=84901834157&partnerID=8YFLogxK
U2 - 10.3109/07420528.2014.901973
DO - 10.3109/07420528.2014.901973
M3 - Article
C2 - 24673295
AN - SCOPUS:84901834157
SN - 0742-0528
VL - 31
SP - 787
EP - 796
JO - Chronobiology International
JF - Chronobiology International
IS - 6
ER -