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Treatment of pain in pregnancy
Martha J Wunsch1, Valerie Stanard, Sidney H Schnoll
1Department of Pediatrics, Edward Via Virginia College of Osteopathic Medicine, Blacksburg 24060, USA. mwunsch@evvcom.org
Background:
The treatment of pain during pregnancy other than that of labor is a clinical issue that has not been addressed in a systematic manner.
Materials And Methods:
To assess current knowledge, a review of the human and animal literatures was undertaken using MEDLINE. In addition, the dynamics of three pharmacological compartments, the mother, the placenta, and the fetus, and fate of drugs given in pregnancy, was reviewed.
Results:
The literature review yielded little information except for a few case studies in which opiates, nonsteroidal anti-inflammatory drugs, antidepressants, mu agonists, and anticonvulsants were used in the treatment of pain in pregnancy. In contrast, there is extensive information in the addiction medicine literature concerning the use of opioids in recovering pregnant addicts. Methadone, buprenorphine, and morphine have been used to treat women seeking recovery from opioids, and neonatal outcomes have been closely monitored with no evidence of harm to the newborn.
Conclusions:
Experience in women seeking recovery from opioids and their newborns illustrates that opioids are an effective and safe pharmacological option for the treatment of pain during pregnancy. Controlled studies are needed to expand knowledge in this clinical area.