PAIN MANAGEMENT IN PREGNANCY

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(Date of issue: July 2019, Version: 3)

This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a pregnancy reporting form. Please encourage all women to complete an online reporting form.

Summary

There are no specific guidelines for the management of pain in pregnancy. Choice of analgesic should largely be guided by treatment recommendations for the same type/severity of pain in non-pregnant patients, but will also need to take into account possible risks to the fetus. Severe or chronic pain, if left inadequately treated or untreated, can potentially have adverse effects on the mother and therefore the fetus.

Where possible/appropriate, non-pharmacological measures should be attempted before drug therapy is considered. If non-pharmacological measures are not effective or are considered inappropriate, medication should be initiated appropriate to the level of pain indicated by a pain scale, as is routine in the non-pregnant population. However, it should be borne in mind that not all analgesics recommended in commonly used pain ladders are suitable for use during, or at certain stages of, pregnancy. Neuropathic, chronic, or other complex pain syndromes are likely to require specialist management and women with these conditions who are pregnant or considering pregnancy should be referred to a specialist with expertise in managing pain in pregnancy.

The final decision regarding the pain relief regimen for a pregnant patient remains the clinical responsibility of the prescriber. Consideration should be given to the balance between known or unquantified fetal risk and maternal benefit from pain relief.

Certain medications used as analgesics are associated with increased risk of fetal malformation (e.g. carbamazepine) or other adverse effects at particular stages of pregnancy (e.g. NSAIDS after the first trimester) and are therefore not recommended for use in pregnancy or at particular stages of pregnancy unless absolutely necessary. Human pregnancy safety data are extremely limited for some anticonvulsants and antidepressants used in the management of certain pain syndromes and these limitations should be discussed with the patient when considering possible treatments. Please refer to the respective UKTIS monograph(s) for the relevant drugs, or telephone UKTIS for case-specific advice.

Neonatal withdrawal may occur with use of centrally acting analgesics late in pregnancy. Use of any opioid during pregnancy, particularly around the time of delivery, confers a risk of neonatal respiratory depression.

Exposure to medications used in the treatment of pain at any stage of pregnancy would not usually be regarded as medical grounds for termination of pregnancy, however other risk factors may be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.

This document is regularly reviewed and updated. Only use full UKTIS monographs downloaded directly from TOXBASE.org to be sure you are using the most up-to-date version. The summaries of these monographs are openly available on UKTIS.org

This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to health care professionals at www.toxbase.org.

If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.

If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.

Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from TOXBASE.org or UKTIS.org to ensure you are using the most up-to-date version.