Pain Management in Pregnancy: The Smart Patient’s Guide

By March 20, 2020 June 15th, 2020 Chronic Pain

Pain Management in Pregnancy: The Smart Patient's Guide - Pain Management & Injury Relief

Chronic pain is a major issue that affects over a third of the total adult US population, and it is the most common cause of disability. Women experience problems with chronic pain more often than men. Managing chronic pain is often an incredibly challenging task for patients and healthcare providers alike. This is due to the many confounding factors that affect pain and its perception. Pregnancy further complicates the issue, placing stress on the mind and body, especially the spine.

Estimates to determine the prevalence of preexisting chronic pain disorders among pregnant women are unknown. However, the numbers suggest that a sizeable portion of pregnant women struggle with chronic pain issues, and 14 percent of women fulfill a prescription for opioid medication at least once during the antepartum period. Another study suggests prescription opioids were dispensed to approximately 21 percent of women during pregnancy. Aside from non-obstetric pain, back pain is an incredibly common obstetric complaint.

Both obstetric and non-obstetric pain symptoms present a serious risk to both the patient’s well-being. This is because of the fetal development of their offspring. There are developmental problems with hypertension, cardiovascular stress, depression, and anxiety during pregnancy. Severe chronic pain is also linked to cardiovascular disease, and chronic illnesses can lead to a miscarriage.

It’s clear that there’s a great need for research and clarity on the matter. Millions of expecting mothers struggle with symptoms of chronic and intractable pain. Here’s what we know about pain management during pregnancy.

Pain Medication During Pregnancy

As previously mentioned, research indicates that anywhere from 14 to 21 percent of pregnant women fulfill an opioid prescription at some point during their pregnancy, and 2.2 percent were dispensed an opioid three or more times during their pregnancy. These findings suggest that opioid use during pregnancy is relatively common. Because of the expected prevalence of both obstetrics-related pain and non-obstetric (preexisting or otherwise) chronic pain.

Current research indicates that opioid use may be dangerous during pregnancy, but there is still a lot of precedent to support it in spite of the risk due to the alternative risks that both the mother and fetus face when subjected to intractable pain to long periods of time without relief or proper management.

Opioids are not the only form of medication that a doctor can prescribe during pregnancy. In fact, most expecting mothers are first prescribed non-opioid painkillers including acetaminophen. Acetaminophen with opioid medication is the most common pain drug in use during pregnancy (43.2 percent usage).

Based on what we know, acetaminophen presents a lower risk of adverse effects during pregnancy, although some research suggests acetaminophen use during early pregnancy may be linked to the development of ADHD and autism. On the other hand, NSAIDs and opioids are linked to an increased likelihood of certain birth defects, and in the case of opioids, neonatal abstinence syndrome. However, opioids may be necessary in order to save the mother and child’s lives during pregnancy. This is in cases of where non-opioid medication simply is not enough to treat the pain.

Current pain management guidelines during pregnancy stress the use of both pharmacological and nonpharmacological treatments. But in some cases, the use of opioids cannot be avoided. Acetaminophen continues to be the first-line treatment for pain alongside nonpharmacological treatment such as physical therapy.

Why Pain Medication Is Still Important 

Even though they are documenting the adverse effects of pain medication during pregnancy, the rates for these adverse effects are still low. The same research that discusses these risks also seems to suggest that using therapeutic doses is “relatively safe”, and that the use of the lowest effective dose can minimize fetal risk while still addressing life-threatening pain.

Prescribing both opioid and non-opioid pain medication must be done with great care.Some mothers are at greater risk of adverse effects than others based on medical history and current symptoms. This ranges from previous history of addiction to how far along they are (No NSAIDs after 32 weeks, for example, to minimize the risk of prolonged bleeding).

The appropriate pharmacological response to a pregnant patient’s intractable pain can lead to a healthier pregnancy, especially for women struggling with preexisting chronic pain conditions such as chronic fatigue syndrome, fibromyalgia, and chronic myofascial pain and dysfunction.

Nonpharmacological Treatments Are Critical

Targeted interventions, nonpharmacological treatments, and alternative treatments all play a vital role in a proper multimodal approach to pain management during pregnancy. Some potential interventions include the use of nerve blocks and corticosteroids to temporarily address severe chronic pain in specific areas of the body. This includes the back and legs. It’s critical to approach these interventions with care.

Physical therapy is an effective means of addressing mild pain throughout the pregnancy. This includes during the planning stages, as it helps the body better prepare for pregnancy. Cognitive-behavioral therapy and other forms of talk therapy/psychotherapy may be vital in cases where chronic pain is coexisting with psychiatric conditions such as depression and anxiety.

For some women, alternative therapies like acupuncture provide further relief. However, it is important not to rely solely on these alternative therapies, or any single modality for that matter. For an effective multimodal approach, patients must work with their healthcare providers during the early stages of pregnancy. Especially if they have a preexisting condition.

You should discuss with your doctor a multimodal approach. To have effective therapies, a medical professional needs to look at a patient’s history and circumstances. Concerns and considerations regarding  pain management of chronic conditions during pregnancy are numerous.

This ranges from the risk of addiction to the risk of abrupt drug cessation without a tapering phase, leading to opioid and/or benzodiazepine withdrawal. It depends on a patient’s medication, which can greatly endanger the pregnancy. That is why an in-depth consultation with a medical professional is important.

Work With Your Doctor and Pain Specialist

Only 41 percent of women with chronic pain discuss pain management before a pregnancy. And among a sample of pregnant women with back pain, only a third talk about their symptoms with their prenatal care specialist. Many women who rely on pharmacological treatment for their chronic pain or psychiatric condition immediately cease using their medication. This is  for fear of teratogenicity, rather than tapering.

There is a  lack of communication between pregnant women and healthcare providers on the topic of pain management. Plus there is a high rate of unplanned pregnancies in the general US population (50 percent). So women with chronic pain conditions have a greater need for  family planning addressing their pain management needs. It’s critical to consult your doctor, pain specialist, or prenatal care provider if you are pregnant. It’s important to talk about effective pain management.

 

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