Pregnancy, Pain, and Pills...Oh My!
Pregnancy happens. Sometimes pregnancy happens when someone already has chronic pain. Sometimes pregnancy happens and causes a painful condition. In both cases, a woman expecting a child may find herself with many questions about the pills for treating pain. This topic is like a giant elephant in the room that no one wants to talk about. Fear can paralyze productive discussion. Coming into the opening turn of this discussion, let’s talk about some of the delicate issues surrounding pregnancy, pills, and pain.
Pain and pregnancy are commonly found together in the same unfortunate woman. In fact, one of the most common causes of low back pain is pregnancy-called pregnancy related back pain. As the ligaments relax and the body weight increases during pregnancy, the low back can feel quite a bit of strain. The growth of the abdominal wall stretches the important abdominal muscles that support the low back like a built in corset. All in all, these changes that occur during gestation can leave a woman in a lot of pain. However, some women who wish to start a family are already in pain. Willing to risk increased pain from motherhood, these women may already be dependent on medications to control the pain and do not know what to do. In fact, any woman, who finds herself pregnant and in pain, may have many questions about pain pills.
If a woman has pain, pregnancy and pill questions, the first thing to do is to talk with a doctor, an OB-GYN and pain specialist would be preferable. Some types of pain can be treated without pills and that is the absolute best way to absolutely insure no risk to the fetus. When pills do become necessary, a pregnant woman absolutely needs to be aware of the pregnancy safety rating for a particular drug. Drugs are rated by the FDA as follows:
A: Controlled studies in women fail to demonstrate a risk to the fetus in the first trimester, and there is no evidence of risk in later trimesters; the possibility of fetal harm appears to be remote.
B: Either (1) animal reproductive studies have not demonstrated a fetal risk but there are no controlled studies in pregnant women or (2) animal reproductive studies have shown an adverse effect (other than decreased fertility) that was not confirmed in controlled studies on women in the first trimester and there is no evidence of risk in later trimesters.
C: Either: (1) studies in animals have revealed adverse effects on the fetus and there are no controlled studies in women or, (2) studies in women and animals are not available. Drugs in this category should be given only if the potential benefit justifies the risk to the fetus.
D: There is positive evidence of human fetal risk, but the benefits for pregnant women may be acceptable despite the risk, as in life-threatening diseases for which safer drugs cannot be used or are ineffective. An appropriate statement must appear in the “Warnings” section of the label of drugs in this category.
X: Studies in animals or humans have demonstrated fetal abnormalities, there is evidence of fetal risk based on human experience or both; the risk of using the drug in pregnant women clearly outweighs any possible benefit. The drug is contraindicated in women who are or may become pregnant. An appropriate statement must appear in the “Contraindications” section of the labeling of drugs in this category.
Clear as mud, right? This rating system often leaves doctors and mothers-to-be very confused, so the FDA wants to scrape this system and replace it with clear language that everyone can be clear about. But for then, we have this system as a rough guide. Let’s review some ratings of common pain medications.
Ibuprofen: B (except, not recommended in third trimester)Acetaminophen: BOxycodone: BMethadone: CBuprenorphine: C (Buprenorphine alone is preferred over Suboxone)Morphine: C (caution in third trimester)**
Well, this list goes on and on. In general, the opioids are all rated as a “C” because of the risk to the fetus. The opioid chemical dependency in the mother is passed on to the fetus. When the baby is born, the newborn can experience withdrawal symptoms-neonatal abstinence syndrome. For this reason, a woman with chemical dependency to opioids needs to seek specialty care when she becomes pregnant.
Any woman with pregnancy, pain, and pills needs special consideration because the health of the mother and fetus are at stake. Being afraid to ask questions or being afraid to give answers does not help this potentially dangerous situation. When an elephant is in the room, talk about it. Pregnancy happens. Pain happens. And solutions can be found.
Please take a moment to share your experiences and opinions about this topic.
Christina Lasich, M.D., wrote about chronic pain and osteoarthritis for HealthCentral. She is physiatrist in Grass Valley, California. She specializes in pain management and spine rehabilitation.