“Women should be reassured that any pain they experience can be treated during pregnancy, & that they need not suffer unnecessarily. Overall, appropriate therapeutic doses of commonly used analgesics, have not been associated with an increased incidence of birth defects. The use of non-steroidal anti-inflammatory drugs in the third trimester is however, not recommended. Untreated persistent pain can have adverse effects for the mother & her pregnancy, & women with persistent pain should optimise their pain management [by discussing it with a Pain Consultant], before pregnancy” [1]
Putting a Spotlight on Pain Management During Pregnancy
Opioids
Patients who report continual pain to their Pain Specialist, may require high doses of opioids during their pregnancy. Opioids including: codeine, morphine, oxycodone, hydrocodone, hydromorphone; and pharmaceuticals such as tramadol and pethidine, are often used by Pain Doctors who want to control their patients’ moderate to severe pain levels.
Of note:
“Generally speaking: “opioid analgesics have not been associated with an increase in birth defects or other adverse outcomes, such as miscarriage. There are also reassuring data on longer-term neurodevelopmental follow-up in exposed infants” [1]
Tricyclic Antidepressants
In some instances, alternatives to opioids – such as tricyclic antidepressants, may help to control a patient’s consistent pain, and thus lower their exposure to opioids (and any potential risk of addiction). Of note: tricyclic antidepressants have not been linked to long-term neurodevelopmental issues, or an elevated rate of birth defects [1].
The Best Way Forward
In light of the aforementioned, it is strongly recommended that patients book an in-person or online consultation with an experienced Pain Specialist, who, after reviewing their medical history, asking the patient pertinent questions, and conducting any necessary tests and scans, will compile a Holistic Personalised Treatment Plan. They will also explain all the elements of the treatment, in clear, easy to understand, layman’s terms.
The success of this protocol will involve the Pain Doctor regularly monitoring the patient’s condition, and the Pain Doctor and their team, always being contactable to answer any questions, or address any concerns. – Both of which often occur, particularly in the case of first time pregnancies. This registration with, and link to an experienced Pain Consultant, empowers the mother-to-be with high grade professional guidance, along with comfort and reassurance. – Something which can also be reassuring to the patient’s partner and family.
Reference
[1]. Kennedy, D. (2011). “Analgesics and pain relief in pregnancy and breastfeeding.” NPS MwdicineWise.”
https://www.nps.org.au/australian-prescriber/articles/analgesics-and-pain-relief-in-
