Pain relief
(Date: July 2019. Version: 3.0.1)
This factsheet has been written for members of the public by the UK Teratology Information Service (UKTIS). UKTIS is a not-for-profit organisation funded by the UK Health Security Agency (UKHSA) on behalf of UK Health Departments. UKTIS has been providing scientific information to health care providers since 1983 on the effects that medicines, recreational drugs and chemicals may have on the developing baby during pregnancy.
General information
Pain in pregnancy is common. There are no specific guidelines on the treatment of pain in pregnancy. If a painkiller (sometimes called an analgesic) is required, the choice will depend on the type and severity of pain and the stage of pregnancy. A doctor may assess your pain on a ‘pain scale’ to help decide the most suitable treatment. Pregnant women with long-term conditions that are associated with pain may be cared for by a specialist.
For specific information on treatment of migraine in pregnancy please see the bump leaflet on migraine.
Is it safe to use painkillers in pregnancy?
When deciding whether to use a painkiller during pregnancy it is important to weigh up how necessary the treatment is against any possible risks to you or your baby, some of which might depend on how many weeks pregnant you are. The non-steroidal anti-inflammatory drug (NSAID) family of painkillers (including ibuprofen, naproxen and diclofenac) are not suitable for use in the third trimester of pregnancy (see below). Other painkillers such as paracetamol and codeine can be safely used at any time during pregnancy.
What are the recommended treatments for pain in pregnancy?
This is largely dependent on the type and severity of the pain.
Mild/moderate pain
Where appropriate, your doctor may initially recommend trying non-drug treatment options, such as:
• Relaxation and deep breathing techniques
• Gentle exercise
• Physiotherapy
• Acupuncture
• Application of hot and cold packs
• TENS
• Pain management programmes
Paracetamol is regarded as the medicine of choice for mild-to-moderate pain in pregnancy. It has a good safety profile based on a large number of pregnant women studied, and although possible links with autism and ADHD in children who were exposed in the womb have been suggested, these findings are considered by some experts to be unconvincing and remain unproven. For more information please see the bump leaflet on Paracetamol use in pregnancy.
NSAIDs such as ibuprofen, diclofenac and naproxen might be prescribed by a doctor for use in the first and second trimesters. NSAIDs should not be used after 30 weeks of pregnancy as they may affect the wellbeing of the baby. For more information please see the bump leaflets on Ibuprofen , Diclofenac and Naproxen. PLEASE BE AWARE: The advice about use of NSAIDs in pregnancy has recently changed. It is now recommended that prolonged use of NSAIDs should be avoided after 20 weeks of pregnancy. The advice to avoid any use of NSAIDs after 30 weeks of pregnancy has not changed. For more information, please see the information here. We will be updating this document as soon as possible to include the new advice.
Codeine has a number of side effects, and use in pregnancy, especially in the weeks leading up to delivery, can result in withdrawal symptoms in the baby after birth. It may therefore only be offered by your doctor if the previous treatment options have not worked, are not suitable for you, or could not be used. Further information on the fetal effects of use in pregnancy can be found in the bump leaflet on Codeine.
Severe pain
Opiates/opioids
The opiate/opioid family of painkillers (including morphine, tramadol, oxycodone, fentanyl, diamorphine, buprenorphine and meptazinol) are used to relieve severe pain and some are used during labour. Repeated use can lead to these drugs becoming less effective and they are also addictive, however their use may be considered necessary in some people. Pregnant women who require ongoing treatment with opiates/opioids will usually be cared for by an obstetrician. Only small numbers of pregnant women taking these medicines have been studied. When deciding whether to use an opiate/opioid in pregnancy your doctor will help you to weigh up the benefits of treatment against any possible risks to you and your baby. Use of any opiate/opioid medicine around the time of delivery may mean that the baby needs some help with its breathing after birth, and can also cause withdrawal symptoms in the baby which may require some short-term treatment.
For specific information on use of some of these medicines in pregnancy please see the individual bump leaflets on morphine, tramadol, and fentanyl.
Treatment of neuropathic pain in pregnancy
Neuropathic pain (nerve pain) is often severe and is generally not relieved by standard painkillers such as paracetamol and ibuprofen. Conditions which cause neuropathic pain include diabetic neuropathy, shingles and sciatica. There are no specific guidelines for the treatment of neuropathic pain in pregnant women. Treatment should usually be overseen by an obstetrician and pain specialist, and medication options may include amitriptyline (usually offered first) and then possibly duloxetine, gabapentin or pregabalin. Amitriptyline is quite commonly used in pregnancy, whereas duloxetine, gabapentin and pregabalin are less commonly used to treat pain in pregnancy.
When deciding which medicine to use, your doctor will help you to weigh up the benefits of each treatment against any possible risks to you and your baby. Use of some of these medicines around the time of delivery can cause withdrawal symptoms in the baby which may require some short-term treatment. For specific information on these medicines please see the individual bump leaflets on amitriptyline, duloxetine, gabapentin, and pregabalin.
What if I have already used a painkiller during pregnancy?
Paracetamol is the painkiller of choice for use in pregnancy and its use does not require medical supervision. It is not uncommon for women to have used other types of painkiller early in pregnancy before finding out they are pregnant. In general, this type of use is not expected to harm the baby. It is important that women who take an NSAID long-term who become pregnant consult their doctor as, if possible, their medicine will need to be altered before week 30 of pregnancy.
Pregnant women with long-term pain and/or specific pain conditions should speak to their doctor about appropriate pain relief options. Women taking opiates/opioids and painkillers for neuropathic pain around the time of delivery may be advised to have their baby at a hospital with facilities for treating the baby after birth for any withdrawal symptoms.
Who can I talk to if I have questions?
If you have any questions regarding the information in this leaflet please discuss them with your health care provider. They can access more detailed medical and scientific information from www.uktis.org
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General information
Up to 1 out of every 5 pregnancies ends in a miscarriage, and 1 in 40 babies are born with a birth defect. These are referred to as the background population risks. They describe the chance of these events happening for any pregnancy before taking factors such as the mother’s health during pregnancy, her lifestyle, medicines she takes and the genetic make up of her and the baby’s father into account.
Medicines use in pregnancy
Most medicines used by the mother will cross the placenta and reach the baby. Sometimes this may have beneficial effects for the baby. There are, however, some medicines that can harm a baby’s normal development. How a medicine affects a baby may depend on the stage of pregnancy when the medicine is taken. If you are on regular medication you should discuss these effects with your doctor/health care team before becoming pregnant.
If a new medicine is suggested for you during pregnancy, please ensure the doctor or health care professional treating you is aware of your pregnancy.
When deciding whether or not to use a medicine in pregnancy you need to weigh up how the medicine might improve your and/or your unborn baby’s health against any possible problems that the drug may cause. Our bumps leaflets are written to provide you with a summary of what is known about use of a specific medicine in pregnancy so that you can decide together with your health care provider what is best for you and your baby.
Every pregnancy is unique. The decision to start, stop, continue or change a prescribed medicine before or during pregnancy should be made in consultation with your health care provider. It is very helpful if you can record all your medication taken in pregnancy in your hand held maternity records.
www.medicinesinpregnancy.org