Chronic Pain During Pregnancy: What You Should Know
While there’s not a lot of research available on pregnant people and chronic pain, it’s clear that pain in pregnancy, either due to a preexisting chronic condition or due to pregnancy itself, is not a rare occurrence.
We can learn through the studies that have been done and from talking to people who have been pregnant and those that care for them. The willingness of women who have experienced chronic pain in pregnancy to speak up and share their experiences has helped form medical opinions that can be useful as you work with your doctor or midwife to help figure out how best to cope with your pain in pregnancy.
Chronic pain prior to pregnancy
There is no strong data that speaks to how many people have chronic pain during pregnancy. What we do know, however, is that chronic pain prior to pregnancy increases the amount of sick leave used during pregnancy. Additionally, according to one 2012 study, chronic pelvic and back pain were associated with insomnia in pregnancy.
There are numerous diseases and conditions that may cause chronic pain; these can occur in people who are also pregnant. How pregnancy affects your chronic pain condition varies from person to person and condition to condition.
For example, if you have rheumatoid arthritis (RA), your RA may get better in pregnancy,, reducing your pain, only to flare in the postpartum period. Pregnant people with Erhlers-Danos syndrome can also notice an increase in pain from the natural hormonal changes of pregnancy. Additionally, a 2015 study of women with chronic vulvar pain due to vulvodynia found they often discontinued medications prior to pregnancy; some of the women’s pain improved during pregnancy and others’ worsened, but nearly all of the women in this study experienced increased anxiety about the pain during pregnancy.
Chronic pain that develops as a part of pregnancy
Ask any pregnant person — there are times when being pregnant doesn’t feel so great. In fact, just over 70 percent of people report low back pain in pregnancy. Part of the problem with treating this pain is that it isn’t well understood, even though it’s a major symptom. The recommendations for treatment vary widely and usually do not include medications, which is not always appropriate. Treatments often tried include braces, massage, exercise, education, and acupuncture.
You may also find that you experience lower extremity pain in pregnancy or in the postpartum period. This includes hip, knee, leg, or foot pain.
Medical treatments for pain in pregnancy
Pain in pregnancy should be treated. When left untreated, you are at risk of anxiety and depression in addition to your pain. Thankfully, there are medications available that can help. But which medication when?
The first trimester is the riskiest time for the baby’s development. Therefore, good preconceptional health care appointments and planning for pregnancy is crucial to be able to have a plan prior to pregnancy and initiate it as soon as possible. The good news is that miscarriage is not caused by analgesic medications, and there are only small risks of birth defects seen from using opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) in the first trimester, according to a 2016 study in the journal Drugs. However, it is still preferred that NSAIDs be avoided in early pregnancy if possible.
Toward the end of pregnancy, it’s wise to avoid using acetylsalicylic acid (ACA) and NSAIDs because there is an increased risk of bleeding and potentially the premature closing of your baby’s ductus arteriosus (a key blood vessel). Acetaminophen can be used throughout pregnancy with little risk.
Headache medication and treatment
About 25 percent of women of childbearing age experience migraines. If you had migraines prior to pregnancy, they may get better without treatment during pregnancy. However, if you need treatment, there is no reason to discontinue the triptans during pregnancy, although there is more data supporting the use of the sumatriptan during pregnancy. Have that conversation with your neurologist prior to pregnancy or as early as you can.
Opioids in pregnancy
One physician’s group recommends that opioids are tapered and given at the lowest effective dose, and that these pregnancies are cared for by only specialists in the highest-risk pregnancies. This is not always practical or necessary, but working with your team certainly is required. While there is also risk in continuing opioids throughout pregnancy, this is thought to be a small risk overall, and for some people if it is absolutely necessary. The risk of birth defects is low.
Outside of the first trimester, however, opioid use is linked to a small risk to your pregnancy of preeclampsia and preterm birth; however, this risk is also seen with analgesic use, to put that in perspective. At the end of the day, data on opioids in pregnancy is limited, and your needs should be taken into consideration when making a decision regarding treatment with your care providers.
Neonatal abstinence syndrome
If you have taken pain medication in pregnancy, your baby may be at risk for neonatal abstinence syndrome (NAS). NAS is a miserable thing for a newborn, so the key is working with your pain management team to help you reduce the risk by taking the right amount of specific medications to control your pain. Even when medications aren’t misused, NAS can sometimes occur. The delivery and pediatric team working with you will know to watch for signs and step in quickly to help you and your baby if needed. These risks may be greater if opioids are used in the third trimester. NAS, particularly when untreated, can have adverse effects on your baby later in life.
Questions to ask your doctor about chronic pain during pregnancy
Starting conversations with your doctor early on about the potential for pain during pregnancy can help you come up with a game plan should issues arise. Here are some helpful questions to ask to get the discussion going:
Do you have experience working with pregnant people who have had issues with chronic pain?
What do you see your role in the process as being? My role?
Are you open to learning more about alternative forms of treatment that you may have previously not worked with (e.g. acupuncture, TENS, etc.) in pregnancy?
How will you ensure the healthiest outcome for the baby?
Why are you recommending this particular medication? What are the risks of this medication? Do the risks change depending on where I am in pregnancy? Is it also safe for breastfeeding?
In the end, the best bet is to find a doctor or midwife who trusts you and who you trust when it comes to your pain management. Having a true partnership with your practitioner is the key to getting good obstetrical care, and that includes management of chronic pain, whether you had it prior to pregnancy or it developed during pregnancy.
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