Pain: treatment during pregnancy

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Signposting evidence-based information on the treatment of pain in pregnancy

Condition management

It is important to complete an individual risk assessment for your patient and to apply the principles of prescribing during pregnancy when looking at the available information and making treatment decisions. Check to see if a risk assessment has already been completed by the specialist team.

Untreated or inadequately treated severe or chronic pain, can have adverse effects on the mother and therefore on the foetus.


There are no specific guidelines for the management of pain in pregnancy. You should check to see if there is local guidance for you to use in your area.

Not all analgesics recommended in commonly used pain ladders are suitable for use during, or at certain stages of, pregnancy.

Stepwise recommendations

Non-pharmacological measures should be tried whenever appropriate or possible, before a medicine is considered.

Choice of analgesic should largely be guided by treatment recommendations for the same type or severity of pain in non-pregnant patients, but will need to take possible risks to the foetus into account.

Non-pharmacological management

  • Physiotherapy, hot and cold packs, TENS, and pain management programmes

Pharmacological management

If non-pharmacological measures are ineffective, unsuitable or symptoms do not respond adequately, oral analgesia may be considered.

  • Paracetamol is the analgesia of choice for mild to moderate pain and pyrexia.
  • Weak opioid codeine may be used where paracetamol has not been effective.
  • NSAID (ibuprofen preferred), may be used if needed for inflammatory pain in first trimester.
  • Systemic NSAIDs are contraindicated after week 28 of pregnancy due to the risks of
    • premature closure of the ductus arteriosus and renal dysfunction in the foetus
    • increased maternal bleeding time and reduced uterine contractions during labour.
  • A MHRA Drug Safety alert highlights the risk from prolonged use of NSAIDs from week 20 of pregnancy. There is an increased risk of oligohydramnios (low amniotic fluid) and foetal renal dysfunction.
  • Avoid prescribing systemic NSAIDs from week 20 of pregnancy unless clinically required and use the lowest effective dose for the shortest duration.
  • If the patient has been exposed to systemic NSAIDs for several days after week 20 of pregnancy, consider additional antenatal monitoring for oligohydramnios.  Stop the NSAID if oligohydramnios is suspected or if the NSAID is no longer necessary.
  • Advise women not to take over the counter NSAIDs from week 20 of pregnancy without advice from their healthcare professional.
  • Use of any opioid during pregnancy, particularly around the time of delivery risks neonatal respiratory depression.
  • Prolonged use of opioids throughout pregnancy may result in neonatal withdrawal.

SPS provides more detailed information on what opioids can be used for pain relief during pregnancy

Pregnancy outcome information

UK Teratology Information Service (UKTIS) provides an overview on pain management in pregnancy including neuropathic pain; and more detailed information on pregnancy outcomes for many common analgesics including paracetamol, codeine or dihydrocodeine, NSAIDs, ibuprofen, tramadol and morphine.

Patient information

Each of the UKTIS summaries has corresponding Best Use of Medicines in Pregnancy (BUMPS) patient information.

The NHS website provides overviews of various pains in pregnancy: back pain, headaches, pelvic pain and stomach pain.

NHS Medicines A-Z provides a summary statement on the use in pregnancy of specific analgesics.

Support for prescribing decisions in people on interacting medicines, those with swallowing difficulties, renal impairment, or who are pregnant or breastfeeding
SPS protocol templates for the supply and administration of omeprazole for pre planned caesarean section by registered midwives.
SPS PGD template for administering subcutaneous terbutaline sulfate for the reduction of contraction frequency in individuals in labour.
SPS PGD template for the intrapartum administration of benzylpenicillin for prevention of early-onset Group B Streptococcus (GBS) infection in neonates.
Opioid analgesics may be used at any stage of pregnancy at the lowest effective dose for the short-term relief of pain when other analgesics are not effective.
Intramuscular hydroxocobalamin is the preferred treatment choice for management of clinically relevant vitamin B12 deficiency, including during pregnancy.
SPS PGD template for the supply of folic acid 5mg tablets to reduce risk of neural tube defect or compensate for increased folate demand during pregnancy.
SPS PGD template for the supply of aspirin tablets to individuals at risk of pre-eclampsia during pregnancy.
Signposting evidence-based information on the treatment of urinary tract infection in pregnancy
Signposting evidence-based information on the treatment of nausea and vomiting in pregnancy

Update history

  1. NSAID advice updated in line with amended MHRA advice
  1. Changed the link to 'Using opioids for pain in pregnancy' as original one no longer worked.
  1. Published

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