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Pregnancy and pain treatment

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Thanks for joining us Aug. 17 for a live chat with Dr. Paul Christo of Johns Hopkins on pregnancy and pain treatment. If you're suffering from a chronic pain condition, the pain doesn't stop while you're pregnant. Should you alter your treatment? If so, how else can you cope with the pain? Dr. Christo answered questions and concerns about these issues.

Christo is director of the Multidisciplinary Pain Fellowship Training Program at Johns Hopkins University School of Medicine. He also has a radio talk show Saturday nights on WBAL.

Can't make the chat? Send questions in advance to healthcalendar@baltsun.com and return here to read the transcript.

Comments made here are for informational purposes only and do not represent or substitute as medical advice. Patients are advised to consult their own physician or pharmacist for advice, diagnosis and treatment.

 Health chat: Pregnancy and pain(08/17/2011) 
11:31
Baltimore Sun Health: 
Hi, Dr. Christo will be joining us at noon, but feel free to add your questions to the queue now and we'll get to them when the chat starts. We'll be addressing how to treat chronic pain conditions while you're pregnant as well as pain that you get while you're pregnant (such as back pain).
Wednesday August 17, 2011 11:31 Baltimore Sun Health
12:00
Baltimore Sun Health: 
Hi, welcome to our live chat on pregnancy and pain treatment. Dr. Paul Christo, a pain specialist at Johns Hopkins, will take your questions. We'll get to as many as we can within the hour. Let's get started.
Wednesday August 17, 2011 12:00 Baltimore Sun Health
12:01
drchristo: 
Hi, I look forward to your questions today.
Wednesday August 17, 2011 12:01 drchristo
12:02
Baltimore Sun Health: 
Many people have asked us questions during previous live chats about what is safe to take for pain during pregnancy. Is asprin and ibuprofen safe?
Wednesday August 17, 2011 12:02 Baltimore Sun Health
12:02
Baltimore Sun Health: 
Those previous live chats can be found here: http://www.baltimoresun.com/health/bal-health-chats,0,3625121.storygallery
Wednesday August 17, 2011 12:02 Baltimore Sun Health
12:10
drchristo: 
In general, pregnant women should not use aspirin regularly because it's associated with an increased risk of something called gastroschisis (abdominal wall defect that causes herniation of intestines) in the fetus. Ibuprofen and naproxen during the first trimester don't seem to cause birth defects, but drugs like these can reduce the amount of amniotic fluid and can prolong labor and pregnancy. Therefore, anti-inflammatory medicines should be avoided in the third trimester.
Wednesday August 17, 2011 12:10 drchristo
12:12
Baltimore Sun Health: 
So what do you usually recommend for mild pain then?
Wednesday August 17, 2011 12:12 Baltimore Sun Health
12:13
Baltimore Sun Health: 
Readers, don't be shy. We'd love to hear your questions.
Wednesday August 17, 2011 12:13 Baltimore Sun Health
12:14
drchristo: 
Acetaminophen is really the first line medicine for mild pain during pregnancy and is considered safe.
Wednesday August 17, 2011 12:14 drchristo
12:15
Baltimore Sun Health: 
And how about something more moderate to severe pain and the acetaminophen isn't helping?
Wednesday August 17, 2011 12:15 Baltimore Sun Health
12:24
drchristo: 
Opioids (morphine, oxycodone, hydrocodone) would be considered next. They have been considered safe in pregnancy, although a recent study demonstrated that there is an association between using opioids between 1 month before pregnancy to the first trimester and fetal heart defects, spinal bifida, and gastroschisis. This doesn't mean that opioids caused these problems; rather, the researchers found an association, so anybody needing these medicines for pain during pregnancy should weigh the risks and benefits before starting them.
Wednesday August 17, 2011 12:24 drchristo
12:25
[Comment From LoriLori: ] 
How can one determine whether pain is normal or is a sign of something serious? I am in my third trimester and every now and then I experience pain in my lower abdomen. This usually happens when I am in bed and moving around trying to get comfortable.
Wednesday August 17, 2011 12:25 Lori
12:33
drchristo: 
Hi Lori,
Pain occurs in almost all pregnant women due to physiologic and anatomic changes in the body. Many women describe pelvic girdle pain in the region of the pubis/pelvis or in the buttocks and sacroiliac joints of the low back. Your pain may be due to pressure of the baby on ligaments or nerves in the abdominal region. It it's intermittent and lasts for short periods of time, it's probably not serious. If the pain worsens in intensity, changes location, or lasts for longer periods of time, then consult your OB.
Wednesday August 17, 2011 12:33 drchristo
12:34
[Comment From ShelleyShelley: ] 
What do you recommend for a patient who has fibromyalgia?
Wednesday August 17, 2011 12:34 Shelley
12:36
Baltimore Sun Health: 
While Dr. Christo is working on the answer, I'll also point out that we did a live chat on fibromyalgia (in general, not to do with pregnancy) and you can find the transcript here: http://www.baltimoresun.com/health/bal-health-chat-fibromyalgia,0,6940268.htmlstory
Wednesday August 17, 2011 12:36 Baltimore Sun Health
12:48
drchristo: 
Shelley,
The three medicines approved for the treatment of fibromyalgia (pregabalin, duloxetine, milnacipran) are all in pregnancy category C which means that we have no adequate studies on these drugs in pregnant women. I would avoid them unless your pain was intense and debilitated you without using the medicine. Gabapentin and pregabalin cause malformations in studies on rodents as well, but the Gabapentin (neurontin) Pregnancy Registry did not note any increased risk of adverse fetal outcomes. If you need a medicine, a tricyclic antidepressant (elavil, for example) could be considered, but again it's a pregnancy category C drug. A short acting opioid at the lowest dose and as infrequently as possible could be considered later in pregnancy (after the first trimester). Be aware that if opioids are used chronically, then the baby will likely experience withdrawal after birth. Acetaminophen is a first line pain relieving drug, but it's not likely to help in fibromyalgia.
Wednesday August 17, 2011 12:48 drchristo
12:49
[Comment From JustineJustine: ] 
Hi - what kinds of effects can taking pain medication that's not recommended have? Should women worry if they took aspirin once before they knew they were pregnant?
Wednesday August 17, 2011 12:49 Justine
1:02
drchristo: 
Justine,
Most physicians will recommend avoiding as many medicines as possible during pregnancy because most drugs cross the placenta and enter the fetus. That doesn't mean that all drugs cause fetal harm, though and some drugs are necessary to take to control other medical conditions, including pain. Problems with aspirin use typically occur if it's used regularly, not just once. Full dose aspirin and anti-inflammatory drugs should be avoided in the third trimester. Low dose aspirin can be considered safe, but higher doses should be avoided. In general, exposure to a medicine that can cause fetal harm before 31 days after the first day of the last menstrual period results in an all or none effect: either the fetus survives without a problem or the pregnancy is lost.
Wednesday August 17, 2011 1:02 drchristo
1:04
Baltimore Sun Health: 
Can pregnant women get any nerve-blocks for sciatica?
Wednesday August 17, 2011 1:04 Baltimore Sun Health
1:05
drchristo: 
Epidural steroid injections can be performed without x-ray in pregnancy women if they have acute pain that shoots from the back/buttock down the leg and the pain is intolerable.
Wednesday August 17, 2011 1:05 drchristo
1:06
drchristo: 
Thank you for your questions.
Wednesday August 17, 2011 1:06 drchristo
1:06
Baltimore Sun Health: 
That's all the time we have for today. Thanks for your questions.
Wednesday August 17, 2011 1:06 Baltimore Sun Health
1:06
 

 
 
 
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