Pain relief patch during pregnancy

Be sure to tell the chiropractor or acupuncturist that you are pregnant. If you have severe back pain during pregnancy or back pain that lasts more than two weeks, talk to your health care provider. He or she might recommend medication such as acetaminophen Tylenol, others or other treatments. Keep in mind that back pain during pregnancy might be a sign of preterm labor or a urinary tract infection. If you have back pain during pregnancy that's accompanied by vaginal bleeding, fever or burning during urination, contact your health care provider right away.

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This content does not have an English version. This content does not have an Arabic version. See more conditions. Healthy Lifestyle Pregnancy week by week. Products and services. Back pain during pregnancy: 7 tips for relief Back pain during pregnancy isn't surprising, but it still deserves attention. By Mayo Clinic Staff. Multimedia Proper lifting during pregnancy. Thankfully this is not the case! Save my name, email, and website in this browser for the next time I comment.

Friday, January 14 - Have a nice day! Share 0 Facebook Twitter Pinterest Whatsapp. Table of Contents hide. However, a different study reported that exercises that help stabilize the pelvic area neither lessened the pain intensity nor reduced the recovery period after delivery [ 70 ].

Please refer to Table 3 for more information about complementary medicine options. Acetaminophen is the drug of choice for pelvic pain during pregnancy. NSAIDs may offer superior pain relief; however, they must be used with caution and should be avoided in the third trimester.

Please refer to Table 2 for more information about specific drugs and their use in each trimester. Pregnancy-related pelvic pain is typically described as a self-limiting condition, and symptoms usually resolve after delivery.

One study showed that pain related to the pelvic joints throughout pregnancy could continue in 8. Abdominal pain in pregnancy has various origins, and while most complaints involve the abdominal viscera, the abdominal wall itself can be a source of chronic pain in pregnancy. The syndrome was first reported in by Dr. Carnett, a Family Physician, in which he outlined nonvisceral pathology contributing to chronic abdominal pain.

Pain is described as very well localized and lateral to the umbilicus. Physical examination will demonstrate a positive Carnett's sign pain worsened with Valsalva maneuvers such as a crunch or sit up and alleviated with rest. In pregnancy, the increasing abdominal wall size can stretch the cutaneous nerves and cause chronic pain. It has been proposed that the changes in the thoracic and abdominal wall from uterine growth can lead to entrapment of the anterior cutaneous nerves [ 72 ].

Ultrasound-guided transversus abdominis plane TAP blocks or rectus sheath blocks can be used to alleviate pain from Anterior Cutaneous Nerve Entrapment Syndrome. The choice of which block to use is indicated by the location of the pain, and these blocks may be considered for both diagnostic and therapeutic approaches. Upon appropriate diagnosis, patients respond very well to TAP blocks or rectus sheath blocks, usually requiring only a single injection [ 73 , 74 ].

In most cases, a combination of stretching and intervention provides the best results. A case series reported on three pregnant women with disabling pain in the lower abdominal pain, all of which responded to local selective block to these nerves [ 72 ].

Intercostal neuralgia may arise as a result of lesions at the level of the spinal cord, nerve trunks, roots, or terminals. It has been suggested that the enlarging gravid uterus, which leads to mechanical stretch on the lower intercostal nerves, can cause intercostal neuralgia [ 75 ]. It has also been proposed that postural variations throughout pregnancy can assist in generating nerve root irritation when the nerves transverse the neural foramina [ 76 ].

Intercostal neuralgia may manifest with radicular pain in the distribution of a thoracic root or intercostal nerve [ 77 ]. Pain is described as a burning or radiating pain, associated with late gestation increased uterine displacement , and occasionally followed by bouts of coughing, which can cause a secondary costochondritis.

Pain usually remits after delivery once pressure on the nerve or root is relieved [ 77 ]. With an ever-increasing rate in the rise of parturient utilizing opioid pain medications, it is reasonable to assume that many obstetricians may be uncertain about adequate treatment options to offer their population. Evaluation as well as effective management is limited by the relative contraindication of radiography in the workup and the risks to the fetus associated with pharmacologic therapy against providing effective analgesia to the patient.

Evidence on nonpharmacologic strategies, while limited, is of value. If pharmacologic therapy is required, the decision to use it must be based on the risks and benefits to the mother and the fetus.

Management of these patients should be with a multidisciplinary team, providing all the therapeutic options to assure the well-being to the patient, minimize fetal teratogenicity, and avoid chronic symptoms and long-term disability.

Nevertheless, an understanding of frequently occurring pain complaints along with quick diagnostic evaluation, risks of pain medications to the maternal-fetal unit, complementary alternative options, and expert consultation allows the obstetrician to easily help women achieve a more enjoyable and functional pregnancy. Dan Broderick, Claudia M.

Santamaria, and Mary E. Authors Gaurav Bhatia and Roneeta Nandi have moved to other institutions since the paper has been completed.

The authors declare that there is no conflict of interests regarding the publication of this paper. National Center for Biotechnology Information , U. Journal List Pain Res Treat v. Pain Res Treat. Published online Sep Shalini Shah , 1 Esther T. Esther T. Author information Article notes Copyright and License information Disclaimer.

Received Jun 10; Accepted Aug This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. Abstract Nonobstetrical causes of pain during pregnancy are very common and can be incapacitating if not treated appropriately.

Introduction Nonobstetrical causes of pain during pregnancy are very common and can be incapacitating if not treated appropriately.

Methodology This narrative review incorporates a descriptive summary and integration of the available evidence on both pharmacological and nonpharmacological approaches to pain management during pregnancy. Common Pain Presentations Throughout pregnancy, several anatomic and physiologic changes occur in the body.

Musculoskeletal and Rheumatologic Pain 4. Low Back Pain Low back pain is a common problem among pregnant women as it impacts approximately half of pregnancies. Etiology Normal changes of pregnancy include mechanical strain from the enlarging gravid uterus and ensuing adjusting lumbar lordosis. Evaluation Diagnostic evaluation can be approached by a focused history and physical exam, which often assists the clinician to rule out other causes of low back discomfort such as pyelonephritis and renal calculi.

Management Most therapeutic strategies encourage preventive measures among pregnant women and those who are planning to become pregnant. Table 3 Complementary medicine. Open in a separate window. Table 1 Classification system for fetal risk. The possibility of harm to the fetus appears remote.

Multivitamins Category B Either animal studies have not demonstrated a fetal risk but there are no controlled human studies or animal studies have indicated an adverse effect that was not confirmed in controlled studies in women in the 1st trimester and there is no evidence of risk in the later trimesters.

The drug is contraindicated in women who are or may become pregnant. Table 2 Specific drugs and indications in each trimester. Use with caution Strong evidence against increased risk of miscarriage [ 20 ], serious birth defects [ 21 ], IQ, or physical growth [ 22 ].

Associated with small increased risk of cryptorchidism in boys [ 23 ] and childhood asthma [ 24 ]. Use with caution Associated with small increased risk of cryptorchidism in boys [ 23 ] and childhood asthma [ 24 ].

Use with caution Associated with increased risk of childhood asthma [ 24 ]. Safe to use No increased risk of hemorrhage if the drug is given to the mother at term in standard doses [ 16 ]. Weak association with early infant exposure first 6 months with increased risk of childhood asthma [ 26 ]; more research is required. Nakhai-Pour et al. A more recent study, with more than 65, women also did not find an increased risk of spontaneous abortion following exposure to NSAIDs [ 29 ].

One prospective study in pregnant patients with inflammatory rheumatic disease did not show a significant association with major birth defects nor harmful long-term effects caused by intrauterine exposure to these drugs when taken early to mid-pregnancy [ 30 ].

There was no drug specificity for cardiac defects. Do not use. NSAIDs are generally linked to premature closure of the ductus arteriosus when taken in the third trimester of pregnancy, which in some cases may result in primary pulmonary hypertension of the newborn [ 16 ]. Large doses taken by mothers in the week before delivery can increase risk of intracranial hemorrhage in premature neonates [ 16 ].

The use of NSAIDs as tocolytics has been associated with an increased risk of neonatal complications, such as patient ductus arteriosus necrotizing enterocolitis and intraventricular hemorrhage [ 16 ].

NSAIDs in general seem to be safe during breastfeeding [ 16 ]. Use only if clearly indicated Three studies including 11, NSAID-exposed pregnancies did not find a significant increase in the frequency of congenital malformations, nor was there an effect upon infant survival compared with unexposed pregnancies [ 32 , 33 ].

Use only if clearly indicated In one study, aspirin was dose-dependently associated with congenital cryptorchidism, particularly during the second trimester [ 36 ]. Do not use, especially if there is increased risk of premature delivery The use of high-dose aspirin close to delivery has been shown to increase the incidence of clotting abnormalities, in addition to neonatal and perinatal bleeding such as hemorrhage in the CNS in the newborn [ 16 ].

Severe neonatal bleeding has been reported after premature delivery [ 37 ]. Premature closure of the ductus arteriosus can result when using a full-dose aspirin in this period. Persistent pulmonary hypertension of the newborn PPHN is a potential complication of this closure. Use with caution Use with caution Do not use Linked to premature closure of the ductus arteriosus, resulting in persistent pulmonary hypertension of the newborn PPHN [ 16 ].

Use with caution Safe for breastfeeding women to use. AAP classifies ibuprofen as usually compatible with breastfeeding [ 25 ]. Use with caution Use with caution AAP classifies ketorolac as usually compatible with breastfeeding [ 25 ]. Use with caution One study found an association between naproxen use and orofacial clefts [ 38 ]. However, the risk for these defects appears to be small [ 16 ]. Use with caution Do not use Linked to premature closure of the ductus arteriosus, resulting in persistent pulmonary hypertension of the newborn PPHN [ 16 ].

AAP classifies naproxen as usually compatible with breastfeeding [ 25 ]. Use with caution Use only if clearly indicated There is inadequate evidence to fully determine infant risk. Should only be used if the possible benefit outweighs the possible risk. Use with caution In general, short-term, episodic use of opiates appears to be safe in pregnancy [ 16 ].

Few studies have evaluated opioid teratogenicity in the first trimester. Overall opinion is that there is minimal risk [ 39 ].

However, one study [ 40 ] showed an association with congenital heart defects, spina bifida, and gastroschisis. This study is limited by recall-bias. Opioid abuse and use of chronic opioids during pregnancy is associated with neonatal abstinence syndrome NAS [ 41 ]. Opioid abuse as well as use of chronic opioids during pregnancy is associated with neonatal abstinence syndrome NAS [ 41 ].

Onset of withdrawal signs is sooner in infants exposed to opioids with shorter half-lives, such as morphine and oxycodone. Use with caution Maternal opioids pass readily into fetal circulation and can cause fetal respiratory depression.

Opioids should be avoided when delivery of a premature neonate is expected. Use with caution The short-term use of opiates during breastfeeding appears to be safe. Infants should be closely monitored for signs of respiratory depression [ 16 , 25 ]. Use with caution Onset of withdrawal signs is sooner in infants exposed to opioids with shorter half-lives, such as morphine. Use with caution Use with caution AAP classifies morphine as usually compatible with breastfeeding [ 25 ]. However, there is inadequate evidence to fully determine infant risk.

However, in another study, no effects were observed on infant survival or congenital malformation rate [ 33 ]. Use with caution Use with caution Use with caution The use of codeine during labor may produce neonatal respiratory depression [ 16 ].

Use with caution. AAP has classified codeine as usually compatible with breastfeeding [ 16 ]. However, toxicity has been reported [ 43 ]. The recommendation is to avoid long-term consumption of codeine-containing products during breastfeeding. Short-term therapy, such as days, with close monitoring of the infant for symptoms of opioid toxicity is recommended [ 16 ].

Methadone-maintenance has been associated with longer gestation and increased birth weights in comparison to nonmaintenance controls [ 44 ]. If maintenance medication is necessary, treatment should begin with the lowest effective dose [ 45 ].

Use with caution Clearance of methadone increases during the second and third trimester, which may cause withdrawal symptoms and necessitate dose adjustment [ 46 ]. Onset of withdrawal signs is longer in infants exposed to opioids like methadone. Use with caution Use with caution Breastfeeding is likely safe, based on studies that show transfer to milk is extremely low [ 16 , 47 ].

AAP classifies methadone as usually compatible with breastfeeding [ 25 ]. Prognosis Within a few months after delivery, most women experience improvement of their pain symptoms [ 6 ]; however, some women continue having residual pain [ 6 ]. Joint Pain Healthy women can present with diverse musculoskeletal changes during pregnancy, such as joint pain.

Etiology Normal physiologic changes seen in pregnancy, such as soft tissue swelling and joint laxity, are also thought to be predispositions to joint pain. Management The current literature on the management of joint pain in previously healthy pregnant women is limited. Prognosis During the postpartum period, there has been an escalation in the onset of new rheumatoid arthritis [ 61 ]. Neuropathic Pain—Carpal Tunnel Syndrome CTS Neuropathic pain can be produced by common conditions including carpal tunnel syndrome and meralgia paresthetica.

Etiology The prevalence of CTS ranges from 2. Management For the management of CTS, both activity modification and the use of splints in neutral position throughout the night have shown some success. Prognosis Symptoms of CTS typically resolve after delivery. Neuropathic Pain—Meralgia Paresthetica 4. Etiology Meralgia paresthetica is a sensory mononeuropathy that specifically involves the lateral femoral cutaneous nerve of the thigh. Management Typically, treatment is usually not needed for meralgia paresthetica and symptoms abate with delivery of fetus.

Prognosis Usually this condition is self-limited and resolves after delivery. Epub Apr Birth defects and drugs in pregnancy. Drugs in pregnancy and lactation. Congenital cardiac anomalies relative to selected maternal exposures and conditions during early pregnancy.

Eur J Epidemiol. Khan K, Chang J. Neonatal abstinence syndrome due to codeine. Neonatal abstinence syndrome and cerebral infarction following maternal codeine use during pregnancy.

Clin Pediatr Phila ; 46 7 — Collado F, Torres LM. Association of transdermal fentanyl and oral transmucosal fentanyl citrate in the treatment of opioid naive patients with severe chronic non-cancer pain. J Opioid Manag.

Neonatal abstinence syndrome due to prolonged administration of fentanyl in pregnancy. Use of a fentanyl patch throughout pregnancy.

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