Chronic pain and long-term disability following postdural puncture headache in obstetric patients: a five-year prospective follow-up of a case-control cohort

Background: Unintended dural puncture is a recognized complication of neuraxial labor analgesia and has been associated with postdural puncture headache (PDPH). While short-term outcomes are well documented, long-term consequences remain poorly characterized. No previous study has reported follow-up beyond two years. Methods: This prospective case-control study followed 336 women up to five years after delivery. The cohort comprised 113 women who delivered without labor epidural analgesia, 113 women who delivered with uncomplicated labor epidural analgesia, 54 women with PDPH following an unintended dural puncture who were not treated with an epidural blood patch, and 56 women with PDPH following an unintended dural puncture who were treated with an epidural blood patch. Outcomes included the prevalence of chronic headache and backache assessed through standardized telephone questionnaires based on International Classification of Headache Disorders criteria, as well as functional impact over time evaluated using the Von Korff chronic pain grade questionnaire. Results: At five years, chronic headache was significantly more common in the two PDPH groups (20.4% with an epidural blood patch and 21.4% without) than in the control groups (5.3% with an uncomplicated epidural procedure and 0.9% without labor epidural; P <0.01). Chronic backache showed a similar pattern (20.8% and 16.1% vs. 5.3% and 0.9%, respectively; P <0.01). Most women reported persistent rather than resolving symptoms. Functional impairment increased over time, with high disability reported in 7 of 16 women (43.8%) with PDPH without an epidural blood patch and 4 of 14 women (28.6%) with PDPH with an epidural blood patch, who reported chronic pain at five years. Conclusions: This five-years follow-up study demonstrates that chronic pain (headache and backache) after an unintended dural puncture is a prolonged condition with substantial functional consequences, challenging its traditional characterization as a transient complication and underscoring the need for long-term follow-up and prevention.