Safe Management of Chronic Pain in Pregnancy in an Era of Opioid Misuse and Abuse

Pritham, Ursula A.; McKay, Laura

doi:10.1111/1552-6909.12487

Cited by 25 publications

(40 citation statements)

References 74 publications

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“…Because many over-the-counter analgesics are predominantly available in combination with other medications [26], all exposure groups included individual analgesic products and products in combination with nonanalgesics. Because many women used both NSAIDs and acetaminophen and because many opioid products include acetaminophen [8,15,27], we created mutually exclusive categories of exposure: (1) NSAIDs without opioids (with or without acetaminophen); (2) opioids without NSAIDs (with or without acetaminophen); (3) both opioids and NSAIDs (with or without acetaminophen); and (4) acetaminophen (without NSAIDs or opioids). As a subanalysis, we further stratified the exposures into mutually exclusive groups based on the most commonly reported specific medications: NSAIDs into ibuprofen, aspirin, and naproxen; and opioids into hydrocodone and codeine.…”

Section: Methodsmentioning

confidence: 99%

“…The selection of safe and effective pain management strategies during pregnancy is challenging [8,9]. Early embryonic exposure to certain pain medications can result in potentially harmful effects on the fetus [9,10].…”

Section: Introductionmentioning

confidence: 99%

“…Early embryonic exposure to certain pain medications can result in potentially harmful effects on the fetus [9,10]. Alternatively, fear about the use of drugs during pregnancy, both substantiated and unfounded, can lead to undertreatment of pregnant women for painful conditions; comorbidities due to inadequate pain management can also be harmful to the fetus [8,9,11,12]. …”

Section: Introductionmentioning

confidence: 99%

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Risk comparison for prenatal use of analgesics and selected birth defects, National Birth Defects Prevention Study 1997–2011

Interrante

Ailes

Lind

et al. 2017

Annals of Epidemiology

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Purpose To compare the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and/or opioids to the use of acetaminophen without NSAIDs or opioids with respect to associations with birth defects. Methods We used data from the National Birth Defects Prevention Study (1997–2011). Exposure was self-reported maternal analgesic use from the month before through the third month of pregnancy (periconceptional). Adjusted odds ratios (aORs) were calculated to examine associations with 16 birth defects. Results Compared to acetaminophen, mothers reporting NSAIDs were significantly more likely to have offspring with gastroschisis, hypospadias, cleft palate, cleft lip with cleft palate, cleft lip without cleft palate, anencephaly, spina bifida, hypoplastic left heart syndrome, pulmonary valve stenosis, and tetralogy of Fallot (aOR range, 1.2–1.6). Opioids were associated with tetralogy of Fallot, perimembranous ventricular septal defect, and ventricular septal defect with atrial septal defect (aOR range, 1.8–2.3), whereas use of both opioids and NSAIDs was associated with gastroschisis, cleft palate, spina bifida, hypoplastic left heart syndrome, and pulmonary valve stenosis (aOR range, 2.0–2.9). Conclusions Compared to periconceptional use of acetaminophen, selected birth defects occurred more frequently among infants of women using NSAIDs and/or opioids. However, we could not definitely determine whether these risks relate to the drugs or to indications for treatment.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk comparison for prenatal use of analgesics and selected birth defects, National Birth Defects Prevention Study 1997–2011

Interrante

Ailes

Lind

et al. 2017

Annals of Epidemiology

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“…Although not the only reason, a lack of confidence in medication has likely contributed to practitioners seeking alternative treatments to help control symptoms of pain (Hollyer et al 2002). Vermani, Mittal and Weeks (2010) concluded in their review that non-steroidal anti-inflammatory drugs (NSAIDs) were safe and had some effect on pain, however, many commonly used NSAIDs are considered to carry an extremely large risk to the foetus if ingested in the first trimester, or after 30 weeks gestation (Pritham and McKay, 2014).…”

Section: Medication Usementioning

confidence: 99%

“…In a literature review and proposal for a clinical care pathway for PPGP, Verstraete, Vanderstraeten and Parewijck (2013) stated that PPGP has a unique clinical presentation and as such should have specific management. Pritham and McKay (2014) stated that research in pregnancy is not as common as it should be, and highlighted the detriment to pregnant women's mental health if pain is left untreated. Baylis (2010) stated that by not investigating pregnant women through research, it denies the possibility of new therapies that could be of benefit and, as a result, a culture of under treating during pregnancy prevails.…”

Section: Introductionmentioning

confidence: 99%

Korean hand acupuncture for pregnancy related pelvic girdle pain: a feasibility study

2016

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This thesis aimed to assess the feasibility of conducting a randomised controlled trial (RCT) into the use of Korean Hand Acupuncture (KHA) for pregnancy related pelvic girdle pain (PPGP). Despite PPGP developing in approximately 20% of all pregnant women, there are currently very few studies that have investigated interventional strategies, with a dearth of UK based studies. Of extant interventions investigated to date, acupuncture has shown some promising findings, although the effects of KHA on PPGP remain unclear. In line with the MRC framework for complex interventions, any potential treatment should be subjected to feasibility testing prior to a definitive RCT. This three phase feasibility study followed a mixed methods paradigm.Phase 1 was a comparative study of 20 non pregnant women, measuring the belief that there had been a needle inserted into the skin, between a penetrating KHA (pKHA) group and a non-penetrating KHA (npKHA) group. Between group analysis found that at initial assessment (p=0.07) and one week post intervention (p=0.643), believability was similar. Qualitative comments were analysed through content analysis, and provided insight into what factors influenced their belief score, such as 'acupuncture noises'. The study findings helped to develop the intervention protocol in Phase 3. This study was the first to investigate the believability of a non penetrating form of KHA.Phase 2 recruited eight PPGP sufferers and adopted a qualitative approach, using semistructured interviews to gain an understanding of how PPGP affected them. Data was subjected to thematic analysis and produced four themes: The reality of PPGP; Support mechanisms most important in PPGP; Vulnerability and; Knowledge is power. Findings indicated PPGP is a problem that is biopsychosocial, and one which is represented via the Pelvic Girdle Questionnaire (PGQ). It demonstrated that information provision was considered as important to the participants within this study as it is to sufferers outside of the UK, and that they valued health care professional advice and support. This is the first UK based study to investigate women's experience of PPGP, the first piece of qualitative work with the lead author and interviewer being male, the first to provide a level of validity to PGQ use within the UK and the first to adopt a pragmatic philosophy.Phase 3 was a mixed methods feasibility study, assessing the acceptability and practicality of conducting a definitive RCT on KHA for PPGP. A two armed study consisting of six sessions in either a standard physiotherapy plus pKHA or a standard physiotherapy plus npKHA group. The study recruited 59 women, 40 of whom completed all six sessions. Acceptability and practicality was confirmed through content analysis of the qualitative data produced by the participants, in particular those in the pKHA group who stated they would seek out the treatment again. Further acceptability was noted as all adverse events experienced were minor and transient, and that the retention of women to the ...

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Pain Management in Pregnancy and Lactation

Yılmaz¹,

Gurbet

Passàli

2022

ENT Diseases: Diagnosis and Treatment During Pregnancy and Lactation

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Safe Management of Chronic Pain in Pregnancy in an Era of Opioid Misuse and Abuse

Cited by 25 publications

References 74 publications

Risk comparison for prenatal use of analgesics and selected birth defects, National Birth Defects Prevention Study 1997–2011

Risk comparison for prenatal use of analgesics and selected birth defects, National Birth Defects Prevention Study 1997–2011

Korean hand acupuncture for pregnancy related pelvic girdle pain: a feasibility study

Pain Management in Pregnancy and Lactation

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