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.

Guidelines

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 and second trimester. NSAIDs should not be given after week 28, unless unavoidable and with appropriate monitoring in place.
  • 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.

A PGD template, developed by SPS and NHSE and reviewed by the RCOG, for the administration of subcutaneous terbutaline sulfate to individuals in labour
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Pregnant women often use herbal medicines as alternatives to conventional medicines and a review of the safety of commonly used herbal medicines is provided
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
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A PGD template, developed by SPS and NHSE and reviewed by the RCOG, for the supply of folic acid 5mg tablets to at risk individuals during pregnancy.
A PGD template, developed by SPS and NHSEI and reviewed by the RCOG, for the supply of aspirin tablets for individuals at high risk of pre-eclampsia
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Update history

  1. Changed the link to 'Using opioids for pain in pregnancy' as original one no longer worked.
  1. Published