Management Of Pain In Pregnancy Research Articles

Chronic Pain Management in Pregnancy: A Review of the Literature

Objective: This review summarizes current literature and explores issues involved in the management of pregnant women with chronic pain conditions. Methods: Articles in this review were selected through searches of Scopus, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane Library, and MEDLINE databases. “Grey” literature such as cross-references from identified articles, clinical recommendations, professional consensus, bibliographies from review articles, and book chapters were also examined for appropriate material. Results: The search yielded 18,401 results in total; however, the majority related to management of labour pain, physiological pain in pregnancy, chronic pain in the nonpregnant population, and opioid maintenance in pregnancy for substance- dependent women. These results were therefore excluded. Sixteen relevant articles were included. A lack of high-quality research in the area, a potential for increased maternal and fetal complications, and the need for multidisciplinary input were identified as issues. Discussion: This is one of the first literature reviews to assess the management of women with chronic pain conditions who become pregnant. Poorly managed chronic pain can have adverse effects on the mother and lead to premature induction of labour and birth of the infant. Despite the apparent risks, there remains an absence of research in this field. Conclusion: It is imperative that research and clinical education are continued in this field. This will enable health care clinicians to provide women with appropriate, evidence-based options for their prenatal care, as well as effective, ongoing management of chronic pain conditions during pregnancy. This article has been peer reviewed.

Analysis of Prenatal Exposure to Opioid Analgesics and Scholastic Skills in Children in Fifth Grade in Norway

Few studies have examined the neurodevelopmental consequences of prenatal exposure to opioid analgesics. Therefore, it is necessary to gain knowledge to inform clinical decisions for pregnant women with moderate to severe pain. To investigate fifth-grade scholastic skills in children with prenatal exposure to opioid analgesics. A cohort study was conducted based on data from the Norwegian Mother, Father, and Child Cohort (1999-2008). These data were linked to the Medical Birth Registry of Norway, and data from Statistics Norway included 64 256 live-born singletons, born to 54 568 mothers who reported pain during pregnancy, were analyzed. The study was conducted from July 1 to December 15, 2021. Self-reported exposure to opioid analgesics during pregnancy, characterized in terms of any exposure, the exposure timing, and the exposure duration. Scores from 3 national tests for children in fifth grade. The tests measured scholastic skills in literacy, numeracy, and the English language. Test scores were standardized to z scores. Differences in z scores were compared between children of mothers exposed to opioid analgesics during pregnancy and children of mothers with only prepregnancy opioid exposure. Of the 64 256 children included, 32 521 were boys (50.6%), and 1483 children (2.3%) were exposed to an opioid analgesic at least once during gestation. All test scores were similar between children with any exposure to opioid analgesics in utero and children with only prepregnancy exposure. Children exposed in the first trimester and those exposed in two or three 4-week intervals during pregnancy scored lower than children of mothers with only prepregnancy exposures on tests in literacy (weighted β [wβ], -0.13; 95% CI, -0.25 to -0.01 and wβ, -0.19; 95% CI, -0.35 to -0.04) and numeracy (wβ, -0.14; 95% CI, -0.25 to -0.04 and wβ, -0.19; 95% CI, -0.34 to -0.05). These differences were small and may not be clinically relevant. In this large birth cohort, prenatal exposure to opioid analgesics had no substantial negative association with fifth-grade scholastic skills. However, adequate pain management in pregnancy may be addressed on an individual patient level, bearing in mind the benefits and risks of different analgesic therapies.

Mepivacaine nerve root block and oxycodone improve pain management in pregnancy with a metastatic bone tumor but compromise newborn respiratory health.

Mepivacaine nerve root block and oxycodone improve pain management in pregnancy with a metastatic bone tumor but compromise newborn respiratory health.

Maternal Complications and Prescription Opioid Exposure During Pregnancy: Using Marginal Structural Models.

Prescription opioids are frequently used for pain management in pregnancy. Studies examining perinatal complications in mothers who received prescription opioids during pregnancy are still limited. The aim of this study was to assess the association of prescription opioid use and maternal pregnancy and obstetric complications. This retrospective cohort study with the Rhode Island (RI) Medicaid claims data linked to vital statistics throughout 2008-2015 included pregnant women aged 12-55 years with one or multiple live births. Women were excluded if they had cancer, opioid use disorder, or opioid dispensing prior to but not during pregnancy. Main outcomes included adverse pregnancy and obstetric complications. Marginal Structural Cox Models with time-varying exposure and covariates were applied to control for baseline and time-varying covariates. Analyses were conducted for outcomes that occurred 1 week after opioid exposure (primary) or within the same week as exposure (secondary). Sensitivity studies were conducted to assess the effects of different doses and individual opioids. Of 9823 eligible mothers, 545 (5.5%) filled one or more prescription opioid during pregnancy. Compared with those unexposed, no significant risk was observed in primary analyses, while in secondary analyses opioid-exposed mothers were associated with an increased risk of cesarean antepartum depression (HR 3.19; 95% CI 1.22-8.33), and cardiac events (HR 9.44; 95% CI 1.19-74.83). In sensitivity analyses, results are more prominent in high dose exposure and are consistent for individual opioids. Prescription opioid use during pregnancy is associated with an increased risk of maternal complications.

Non pharmacological Methods to Reduce Pain in The First Stage of Labor with a Counter Pressure Technique

The Pain is a natural process of labor, but if not handled properly, it will cause another problem, namely increasing anxiety in the labour process. Nowadays many methods are offered to reduce pain in labor, both pharmacological (using drugs) and non pharmacological methods. If possible the choice of non-pharmacologic therapy for the management of pain in pregnancy and labor should be considered before using analgesic drugs. One of an effective non-pharmacological method to reduce pain is with massage Counter Pressure. Article searching conducted in some databases: Google Scholar, Proquest and Science Direct. Keyword used were “Counter Pressure”, “pain”, Labour”and finally got 9 articles matched. Counter Pressure could be categorized as a safe and effective intervention to reduce labor pain at first phase

New persistent opioid use after acute opioid prescribing in pregnancy: a nationwide analysis

To evaluate the association between opioid prescribing during pregnancy and new persistent opioid use in the year following delivery. This nationwide retrospective cohort study included patients aged 12-55 years in Optum's deidentified Clinformatics Data Mart Database who were undergoing vaginal delivery or cesarean delivery from 2008 to 2016, with continuous enrollment from 2 years before birth to 1 year postdischarge. Women were included if they were opioid naive in pregnancy (ie, did not fill an opioid prescription 2 years to 9 months before delivery) and did not undergo a procedure within the year after discharge. The exposure was filling an opioid prescription in pregnancy. The primary outcome was new persistent opioid use, defined as a pharmacy claim for ≥1 opioid prescription between 4 and 90 days postdischarge and ≥1 prescription between 91 and 365 days postdischarge. Clinical and demographic covariates were included. Analyses included descriptive statistics and multivariable logistic regression, adjusting for clinical and demographic covariates. Of 158,425 childbirths identified, 101,013 (63.8%) were by vaginal delivery and 57,412 (36.2%) cesarean delivery. Among all patients, 6.0% (9429) filled an opioid prescription during pregnancy. The factors associated with filling an opioid in pregnancy were having a nondelivery procedure in pregnancy (adjusted odds ratio, 9.60; 95% confidence interval, 8.81-10.47) and having an emergency room visit during pregnancy (adjusted odds ratio, 2.48; 95% confidence interval, 2.37-2.59). Of women who received an opioid in pregnancy, 4% (379) developed new persistent opioid use. The factors most associated with new persistent opioid use were receiving an opioid prescription during pregnancy (adjusted odds ratio, 3.45; 95% confidence interval, 3.04-3.92) and filling a peripartum opioid prescription (1 week prior to 3 days postdischarge) adjusted odds ratio, 2.28, 95% confidence interval (2.02-2.57). Though having a procedure during pregnancy was associated with increased receipt of an opioid prescription, it was also associated with reduced new persistent opioid use (adjusted odds ratio, 0.72; 95% confidence interval, 0.52-0.99). Women who receive an opioid prescription during pregnancy are more likely to experience new persistent opioid use. Maternity care providers must balance pain management in pregnancy with potential risks of opioids.

Medication Use and Pain Management in Pregnancy: A Critical Review.

Pain during pregnancy is common, and its management is complex. Certain analgesics may increase the risk for adverse fetal and pregnancy outcomes, while poorly managed pain can result in adverse maternal outcomes such as depression and hypertension. Guidelines to assist clinicians in assessing risks and benefits of exposure to analgesics for the mother and unborn infant are lacking, necessitating evidence-based recommendations for managing pain in pregnancy. A comprehensive literature search was conducted to assess pregnancy safety data for pharmacological and nonpharmacological pain management methods. Relevant clinical trials and observational studies were identified using multiple medical databases, and included studies were evaluated for quality and possible biases. Paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) are appropriate for mild to moderate pain, but NSAIDs should be avoided in the third trimester due to established risks. Short courses of weaker opioids are generally safe in pregnancy, although neonatal abstinence syndrome must be monitored following third trimester exposure. Limited safety data for pregabalin and gabapentin indicate that these are unlikely to be major teratogens, and tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors have limited but overall reassuring safety data. Many of the included studies were limited by methodological issues. Findings from this review can guide clinicians in their decision to prescribe analgesics for pregnant women. Treatment should be tailored to the lowest therapeutic dose and shortest possible duration, and management should involve a discussion of risks and benefits and monitoring for response. Further research is required to better understand the safety profile of various analgesics in pregnancy.

The Difference Of Pain Labour Level With Counter Pressure And Abdominal Lifting On Primigravida In Active Phase of First Stage Labor

Nowadays many methods are offered to reduce pain in labor, both pharmacological (using drugs) and non pharmacological methods. If possible the choice of non-pharmacologic therapy for the management of pain in pregnancy and labor should be considered before using analgesic drugs. One of an effective non-pharmacological method to reduce pain is with massage. The basis of this theory is the gate control theory proposed by Melzak and Wall (Lliadou, 2009).This study aimed to analyze diference of pain relief on active phase of labour with Counter Pressure and abdominal Lifting. This was an experimental with pre test and post test design. The samples were 42 women on their active phase of labor, 21 women for counter Pressure technic and 21 women for Abdominal Lifting technic. Counter Pressure technic decreased pain of labor with a P-value 0.015 (p<0.05) and abdominal lifting technic significantly decreased pain of labour with a P-value 0.001. Abdominal lifting technic (P 0,001) more effective than counter pressure technic (P 0,015) for pain relief in active phase of labour.

Is osteopathic manipulative treatment effective for low back pain management in pregnancy?

Is osteopathic manipulative treatment effective for low back pain management in pregnancy?

Revealing Trends in Oral Pain Management in Pregnancy Between Obstetricians and Endodontists [6C

Revealing Trends in Oral Pain Management in Pregnancy Between Obstetricians and Endodontists [6C

Pain Management in Pregnancy: Multimodal Approaches.

Nonobstetrical causes of pain during pregnancy are very common and can be incapacitating if not treated appropriately. Recent reports in the literature show that a significant percentage of pregnant women are treated with opioids during pregnancy. To address common pain conditions that present during pregnancy and the available pharmacological and nonpharmacological treatment options, for each of the pain conditions identified, a search using MEDLINE, PubMed, Embase, and Cochrane databases was performed. The quality of the evidence was evaluated in the context of study design. This paper is a narrative summary of the results obtained from individual reviews. There were significant disparities in the studies in terms of design, research and methodology, and outcomes analyzed. There is reasonable evidence available for pharmacological approaches; however, these are also associated with adverse events. Evidence for nonpharmacological approaches is limited and hence their efficacy is unclear, although they do appear to be primarily safe. A multimodal approach using a combination of nonpharmacological and pharmacological options to treat these pain conditions is likely to have the most benefit while limiting risk. Research trials with sound methodology and analysis of outcome data are needed.

Balance in Opioid Prescription during Pregnancy

Balance in Opioid Prescription during Pregnancy

Safe Use of Opioid Analgesics for Chronic Pain in Pregnancy

Poster Presentation Objective To identify safe practices for management of chronic pain in pregnancy. Design Retrospective chart review. We studied three commonly used opioid analgesics, compared neonatal outcomes for each of the agents, and identified potential contributing factors to the incidence of neonatal abstinence syndrome (NAS). Sample Neonatal outcomes were evaluated for all singletons delivered full term during a 42‐month period, whose mothers met inclusion criteria and were taking codeine, hydrocodone, or oxycodone at any dosage three or more times per week. Methods The first phase was the retrospective chart review. Charts for every patient delivered by the perinatology practice for the specified time frame were individually reviewed for appropriateness for the study. Data were manually gathered onto an individual data sheet and de‐identified. Once all charts were reviewed and data collected, data were coded and entered into a spreadsheet and analyzed for trends in neonatal outcomes using descriptive statistics. The second phase was to use the information collected combined with available data from other studies to create practice guidelines. Implementation Strategies Outcomes examined included gestational age at delivery, birth weight, APGAR score, admission to the neonatal intensive care unit (NICU), diagnosis of NAS, length of stay, and treatment required. Maternal demographics were evaluated for any potential impact on neonatal outcome trends. Results Thirty‐one charts met criteria for the study. Nine neonates required a NICU admission. Length of NICU stay ranged from 2 to 10 days with an average NICU stay of 5 days. Two neonates required medical management with methadone. They were the only two with a diagnosis of NAS. Six of the nine were admitted for transient tachypnea of the newborn (TTN) and one was diagnosed as a poor feeder. Baseline data indicated that there is no association between NICU stay and agent used or between specific dosages or use of more than one agent. The study was limited by small sample size and multiple potential contributing factors to observed neonatal outcomes. Conclusion/Implications for Nursing Practice Obstetric and neonatal nurse and practitioners must become knowledgeable about the use of opioid analgesics in pregnancy. The findings of this study indicate the need for further research but support the judicious use of opioid analgesics at minimum effective doses. Thorough evaluation of the neonate at delivery for signs of NAS and TTN is warranted, and supportive care in a NICU environment can ease the transition to extrauterine life without opioid exposure.

Management of back pain in pregnancy

Back pain during pregnancy is a common problem experienced by many pregnant women. Physiological changes during pregnancy are a contributing factor for the development of back pain. Laxity of the sacroiliac joints causes instability and development of sacroiliac pain. The pain may be severe and can interfere with daily activities. Neurological examination is usually normal. A positive straight leg-rising test may indicate herniated disc, which is rare during pregnancy. Noncontrast magnetic resonance imaging is safe in pregnancy. To date, there are no identified adverse effects of the magnetic resonance on the developing fetus, but long-term effects need to be examined. Most back pain in pregnancy can be treated conservatively. Acetaminophen is the drug of choice to treat pain during pregnancy. Epidural steroid injection (ESI) may be considered in certain cases. Data in the literature are deficient regarding the use of ESI in pregnancy, but it appears to be safe based on expert clinical experience. More work is needed to examine the long-term effect of ESI on the mother and the fetus. Surgery is usually postponed until the postpartum period, unless there is progressive neurological deficits or cauda equina syndrome.

Outcomes of infants born to mothers receiving methadone for pain management in pregnancy

Objective: To assess the outcomes of infants born to mothers receiving methadone for the management of pain in pregnancy. Design: A retrospective audit was conducted of neonatal outcomes in 19...