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Written by

Dr Adriana Valente Dr Adriana Valente is a specialist in anaesthesia, critical care and pain therapy in Parma, Italy. She is part of the Study In Multidisciplinary PAin Research (SIMPAR) Group and Young Against Pain (YAP) Project.

Dr Maurizio Marchesini Dr Maurizio Marchesini is employed at the 2nd Service Anesthesia, Critical Care and Pain Therapy at the University Hospital of Parma in Italy.

Dr Marco Baciarello Dr Marco Baciarello is employed at the 2nd Service Anesthesia, Critical Care and Pain Therapy at the University Hospital of Parma in Italy.

Dr Silvana Montella Dr Silvana Montella is employed at the 2nd Service Anesthesia, Critical Care and Pain Therapy at the University Hospital of Parma in Italy.

Treatment of pain in pregnancy: acute and long-term management

Published 10 April 2017

Dr Adriana Valente, Dr Maurizio Marchesini, Dr Marco Baciarello and Dr Silvana Montella discuss the physiological changes that can lead to pain during pregnancy, and the treatment options available

Key learning points

  • Anatomical and physiological changes during pregnancy predispose women to the development of common pain conditions, which can be acute or chronic and due to obstetric or non-obstetric causes.
  • The decision to start pain relief therapy depends on factors such as pain intensity, stage of pregnancy and available options.
  • The relative benefits and risks to the mother and foetus need to be evaluated on a case-by-case basis.

The physiological changes occurring during pregnancy predispose women to a variety of pain conditions, either as a direct consequence of the anatomical and physiological changes in the body, or as a result of pre-existing pain conditions. Pain can be attributed to obstetric or non-obstetric causes.1

Pregnancy can put additional pressure on women with acute and chronic pain conditions, as they would like pain relief but do not want to expose their babies to the potential side-effects of analgesics.


Pain-related conditions

Some of the most common painful conditions during pregnancy are lower back pain with or without sciatica, pelvic girdle pain, symphysis pubis pain (resulting from musculoskeletal adaptations created by the gravid uterus), and hand, wrist, ankle and knee pain (resulting from laxity of the joint’s ligaments).1,2

Additionally, neuropathic pain syndromes can also develop, such as carpal tunnel syndrome, abdominal nerve entrapment and intercostal neuralgia.2


Treatment options

The decision to start pain relief therapy should consider different elements: the intensity of pain, the stage of pregnancy, and available options, including both pharmacological and non-pharmacological approaches.

Today it is possible to take medications during pregnancy with more confidence than in the past. Paracetamol at the lowest effective dose is a first-line drug in all three trimesters; opioids can be used in the short-term and occasionally and healthcare professionals (HCPs) should always refer to the relevant product SPC before prescribing; local anaesthetics are used for peripheral nerve blocks in acute pain. Anti-inflammatory drugs should be avoided in the first trimester because of the risk of miscarriage, and during the second and the third trimester because of the risk of oligohydramnios or premature closure of the ductus. Older anticonvulsant drugs are known to be teratogenic, and should be avoided, especially during the first trimester. These are still sometimes used for neuropathic pain. The relative benefits and risks of every single analgesic drug to the mother and foetus depend on the specific clinical context and they would need to be evaluated from case to case.2,3


  • Dr Adriana Valente is a specialist in anaesthesia, critical care and pain therapy in Parma, Italy. She is part of the Study In Multidisciplinary PAin Research (SIMPAR) Group and Young Against Pain (YAP) Project. Dr Maurizio Marchesini, Dr Marco Baciarello and Dr Silvana Montella are all employed at the 2nd Service Anesthesia, Critical Care and Pain Therapy at the University Hospital of Parma in Italy.


References

  1. Coluzzi F, Valensise H, et al. Minerva Anestesiologica 2014;80(2):211–224.
  2. Díaz RR, Rivera AL. Colombian Journal of Anesthesiology 2012;40(3):213–223.
  3. Shah S, Banh ET, et al. Pain Research and Treatment 2015;2015:987483.

Date of preparation: April 2017; MINT/PAEU-17016