Pain management during pregnancy An expert-based interdisciplinary consensus recommendation

Background Pregnancy and pain of different origins is an unfavorable combination that presents all practitioners with special challenges. Pain negatively affects the homeostasis of humans. Patient compliance and in-depth knowledge of the fetotoxicity and teratogenicity of the substances are necessary to maintain a balance between therapy for the mother and safety of the unborn child. Objectives Experts from various disciplines who are entrusted with the care of pregnant patients with pain have come together to develop drug and nondrug therapy concepts with the aim of providing adequate analgesia for pregnant pain patients. Materials and Methods Relevant questions were formulated by experts and subjected to a literature search. Combined with further national and international recommendations, treatment concepts were developed and discussed in an interdisciplinary manner. Core statements were then drawn up and given recommendation grades. Results Depending on the trimester, paracetamol, ibuprofen, diclofenac, metamizole, and opioids can be administered carefully in the event of pain; special care is required with nonsteroidal anti-inflammatory drugs (NSAIDs ) in the last trimester. COX-2 inhibitors are not recommended. For neuropathic pain, amitriptyline, duloxetine, and venlafaxine are considered safe. Non-pharmacological treatment concepts are also available, namely transcutaneous electrical nerve stimulation (TENS therapy), kinesio tapes, and acupuncture. Lymphatic drainage is recommended in cases of edema, if not caused by preeclampsia. Conclusions A deliberated concept for pain therapy during pregnancy should be initiated with a non-pharmacological intervention and, if necessary, supplemented with pharmacological agents.