Abstract
Background and purpose
The majority of the reviews and studies on chronic pain in pregnancy have primarily focused on the pharmacological and non-pharmacological treatment options. The purpose of our review was to identify evidence-based clinical research for the evaluation and management of preexisting chronic pain in pregnancy, chronic pain associated with pregnancy, and chronic pain in relation to mode of delivery.
Methods
A literature search was undertaken using the search engines PubMed, CINAHL, EBSCOhost, and Web of Science. Search terms used included “chronic pain” AND “pregnant OR pregnancy” OR “pregnancy complications” from inception through August 2016.
Results
The basis of this review was the 144 articles that met inclusion criteria for this review. Based on our review of the current literature, we recommend 7 guidelines for chronic pain management during and after pregnancy: 1) complete history and physical examination; 2) monitor patients for alcohol, nicotine, and substance use; 3) collaborate with patient to set treatment goals; 4) develop a management plan; 5) for opioids, use lowest effective dose; 6) formulate a pain management plan for labor and delivery; and 7) discuss reproductive health with women with chronic pain.
Conclusion
The management of chronic pain associated with pregnancy is understudied. Obstetrical providers primarily manage chronic pain during pregnancy. Some general guidelines are provided for those health care providers until more information is available.
Acknowledgments
We thank Donna Eastham, BA, for her help in editing and submitting this manuscript. This work was supported by the University of Arkansas for Medical Sciences Translational Research Institute (grants ULITR000039 and KL2TR000063) through the NIH National Center for Research Resources and the National Center for Advancing Translational Sciences. The contents are soley the responsibility of the authors and do not necessarily represent the official views of the NIH.
Disclosure
Dr Ray-Griffith currently receives clinical trial support from Neuronetics and has received clinical trial support from Sage Therapeutics. Dr Stowe has received research support from and consulted to GlaxoSmithKleine, Pfizer, and Wyeth Corporations, and received speakers honoraria from the complies, plus from Eli Lilly and Forest Corporations prior to 2008. Dr Stowe received clinical trials support from Janssen Pharmaceuticals and Sage Therapeutics in the past 24 months.
Author contributions
All authors contributed toward data analysis, drafting and critically revising the paper, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.