Chronic pain, drugs and pregnancy

[veeceecee]

Hello all,

Just wondering if any of you have had any experience of coping/managing (or not, as the case may be) with chronic pain during pregnancy.

I have chronic (as yet unexplained) rib/chest pain and am currently taking pregabalin and tramadol for pain (having weaned off stronger meds at larger doses). I know that neither of these is advisable to take when trying for a baby or during pregnancy but the information out there is so limited - GP says to either come off everything or deal with the risk/possibly horrible outcome.

Although I have heard positive stories of women who've had no choice, were medicated throughout pregnancy and ended up with perfectly healthy babies. Whenever I talk to a doc instantly I get the blank face and a shaking of the head, as if staying on meds was more of a selfish choice than a necessity.

Any stories would be great. At wits end and all that. Just want a chance to have a regular pregnancy!

Hope everyones day is going well x

hi hon i did manage to come off my meds for ttc & preg. but at the time i was only on co-codamol & citalopram. when i got severe spd i was too scared to up my meds so suffered horribly in pain, & i'm sure that also can't be good for the baby, all those pain signals & stress going round a mum's body. it was bloody hard.

i'm on tramadol since having lo & tbh i can't imagine coping without it now. sorry i can't advise on taking your meds while preg. i am sure there is a lot of info out there & research online? gp's are gernerally v over cautious about taking ANY meds in preg & they are prob not the best ones to speak to. prob better to speak to your ob/gynae consultant? or speak to the antenatal team at your hospital??

Hey thanks for the message!

Sorry to hear you had such a rough time - certainly I think being in so much pain and the resulting stress isn't good for the baby, but I guess doctors are covering their backs by offering you no alternatives at all.

I've read on various chronic pain and fibromyalgia forums numerous stories of women (palmost entirely from the US) who've had their doctor or obs. get on board with the meds idea and who've had very positive experiences with drugs during pregnancy, but the info is very patchy. There just doesn't seem to be the same level of support - I mean you may find yourself with a super supportive gp but its just pot-luck isn't it?

Trying to stay positive because being stress makes my pain levels rocket but can't help but feel a little hopeless :/

Hi there,
Completely know how you feel, when I fell pregnant, I got different advice from different people. I think the best person to ask is a pain specialist if thats possible.
I came off everything except my Fentanyl patch. which I reduced to the lowest possible dose. I was advised not to come off it as it could cause a miscarriage. My advice from the pain specialsist it that opiates are fine in pregnancy at low doses, occassionaly when baby is born they have a very short lived reaction to withdrawing thats normally very mild (unless you were on high doses). Opiates in fact are preferable to taking things like pregabalin as they have been used for years and years and the effects are known, apparantly this doesnt include tramadol though as its new and is a combination drug.
I have a wonderful 3 year old little boy. It was tough going but most definately worth it.
Good luck
S x

Oh and I conpletely agree with BeaBea, stress and pain during preganancy are also not good. Its a very very hard thing to work out. You need to go with whatever is the best decision for you, your partner and the baby and what you feel most comfortable with.

I had SPD and had a lot of opiates during pg, which are often used but you ideally need to be supervised by a consultant.

From Wikipedia on SPD (I personally wrote most of the entry and got the information from my consultant). The drug regime would apply to any chronic pain.

---

Pharmacological interventions
It is not usually considered advisable to take anti-inflammatory medication in pregnancy, which makes SPD a particularly difficult condition to manage. Women are therefore typically often prescribed 30 mg or 60 mg of codeine phosphate to be taken in conjunction with 1000 mg paracetamol, four times a day. However codeine phosphate is an opiate, and as such carries a risk of depressed respiration in the newborn baby if it is taken near the time of the birth. Therefore it is usually considered advisable to cease taking codeine phosphate 2?4 weeks before the estimated due date, as advised by a medical professional. If this is not possible, then a planned hospital birth is recommended. Other medications in common use include oral morphine.

PS I did not come off the medication and actually had a HB with the agreement of my consultant, but a factor in the was the fact I can practically see the hospital from my bedroom window so we decided the transfer would be so quick that I might as well have a HB. DS3 had a tough-ish day three days after the birth, restless and a bit crying, but nothing that required medical attention. One thing that was recommended was to bf to smooth the withdrawal of the drugs. DS3 is completely normal, btw, and the drugs had no long term effect on him at all.

Can you get to a pain clinic? I went to one becasue I wanted to ttc and I was on trammadol - you really don't want to be on that while ttc or pregnant, it's been shown to be embryotoxic in animal studies - myself and the pain clinic pharmacist agreed this was very very bad! I don't know about pregabalin.

I was switched to morphine sulphate as I've had problems with codiene in the past and it was considered as safe as you can get. I take less than 0.5ml as needed - though I'm only just 13 weks and have so far managed with only paracetamol but my pain levels have reduced since I became pregnant - very strange yes, but once my SPD kicks I'm sure I'll need it more.

The GP is being less than useless - encouraging you to ttc on both trammadol and pregabalin in my opinion is pretty close to malpractice and is certainly neglect. If you have to go to PALS to get a referal to a pain clinic who will take this much more seriously.

You don't have to suffer just becasue you want a family and anyone who suggests otherwise is being an ignorent fascist (as my GP was last pregnancy and blocked my referal for pain management and for pain relief a consultant had prescribed)

I was told that Pregabalin was a definate big no for TTC, its also embryotoxic and you should also wait at least 3 months after coming off of it to TTC. Morphine based drugs are meant to be the safest option and millions of women have used them during pregnancy with no long term effects on the child.

Strangely Trickle my pain was about 80% better during pregnancy. It wasn't just in my mind because I noticed the pain reduction a whole week before I knew I was pregnant (at 5 weeks). Once my son was born, the pain kicked back in badly after 3 days. My GP said it was common but they dont really know why, something to do with your homones naturally protecting your body during pregnancy. I do hope this is an area they research because maybe there's a hormonal based pain reliever that could be developed at some point in the future. It was the lowest my pain levels have ever been, when the pain came back I found it hard as i'd got used to the reduction (plus I had a newborn baby to look after!)

Thanks Sazza, forewarned is forarmed and all that - I'm hoping to breastfeed but it just might not be possible if I need too many opiates if my pain comes back with avengance.

Good luck Trickle, it might be that breastfeeding delays your pain returning, hopefully anyway. Breast feeding didn't work out for us, don't be hard on yourself if you can't. Its about getting a balance of what is best for all of you. Having my son is without a doubt the best thing I could have ever done in my life, its not been easy but i've not regretted it for a single second. He is 3 now and I still look at him and can't believe he's here!

I have been on tramadol for 12 years and it was deteuned that it was safer for me to keep taking it than not. It's also the only med that helps give me any quality of life for pain control.

I has ds1 who is now 4 and had no probs, neither did he (his apgar score was 10 immediately after having him)I breasted him also and again no probs when he stopped feeding.

I am 33 weeks pregnant with ds2 and again all scans, tests etc show he is fine. Hopefully he won't suffer any withdrawal either. My consultant said that my cortisol levels would soar with pain and withdrawal if I stopped taking the tramadol and would be more likely to harm the baby than taking them. I didn't know I could fall pregnant after being told I was infertile so with neither miracle pregnancy did I have an option to try and stop my meds anyway before becoming pregnant.

I reduced my dosage from up to 400mg daily to max of 200mg. My pain levels are higher but it's the level I felt more comfortable at for the baby. I saw the consultant anaesthetist who said that quite a few people have to take tramadol, morphine and other string opiates during pregnancy and aside from a few babies who needed a day or 2 weaning from the medicine, she hadn't ever seen any other problems.

Anyway I hope you find what is right for you.

I know this thread is a bit old now but wonder if anyone can give me any advice or positive out come stories ?? I was on Fentanyl patch for Ehlers Danlos Syndrome and spinal problems amongst other stuff, went down to Morphine when fell pregnant (accidentally on Mirena!!) and have now got down to 5 Dihydrocodeine tabs a day, am in pain but coping, just.

This will be my 6th baby and with the others didnt even drink coffee let alone take anything else :( My pain doc is useless and the obstetrician couldnt give me alot of advice either, Im terrified as to how this will affect my baby and am getting really depressed, anyone who can give any advice would be so appreciated xx

Hi Arabellamilla,
I was on Fentanyl patch throughout my pregnancy, it was reduced to the lowest dose though. I had advice from my GP, a pain specialist consultant and a paediatrician. Morphine in all its forms is safe during pregnancy, obviously its best not to be on it but it isn't an ideal world. I was in fact advised to stay on it as withrawel during preganancy can be dangerous especially early on. The only possible problems from morphine are that baby may experience some withdrawal when they are born. This is normally very minor and requires no treatment and has no long term effects. In cases where mum is on higher doses of morphine (legal or illegal) baby sometimes needs a few doses of morphine thats gradually reduced until they are weaned off it. My consultant pain specialist's wife was on morphine during her pregnancy which I found reassuring!

Depression, stress and pain during preganancy aren't good for baby (or you) so please try not to worry about it so much. My son was absolutely fine when he was born and I have come across many other mums online who have also had perfectly healthy babies. You have done incredibly well to get down to 5 Dihydrocodiene tablets a day, get plenty of rest and be kind to yourself you've done everything you possibly could have done for your baby.
Good luck xx

Thank you so much for your reply sazza76 its really made me feel so much better :) The thing about your docs wife has reassured me too ! Im spending far to much time a day picturing this poorly newborn and feeling pretty selfish and crap :( How did you get referred to a paediatrician ? The pain doctor I saw "advised" I speak to one but didn't actually refer me? Let me know if you get a chance xx

You are absolutely not being selfish. What more could you possibly have done? Nothing at all. I was reffered to a paediatrician by the obstiatrican (cant spell) we saw. You should be seeing one too, if your not, ask your midwife or GP to refer you to one, I think it was my GP who reffered me. Probably the best thing you can do is go to see your GP and ask them to refer you to both an ostiatrician and a paediatrician. We found the paediatrician very reassuring and she came to see my son when he was born as well.
Sorry it took me a few days to check back, feel free to private message me if you want to. Good luck x

Thanks sazza have messaged you, going back to what you said about other mums online, how come they are all from America, cant seem to find any sort of UK support/advice groups ?? Would be good to get a closer to home insight x

Hi, I was on a mixture of medications because of multiple chronic health problems.
Pain medication wise I stayed on the fentanyl and oramorph, but managed to stop pregablin. My baby boy is now 14 months. At time of birth, I had c section, he was fine and very well :-) he had some mild withdrawal effects but didn't need treatment :-)

I had a painful kidney condition brought on by pregnancy, I had cascade kidney stones which meant I passed stones up to several times a day. Excruciating! I didn't have it in my first pregnancy but did in 2 nd and 3 rd. Usual treatment is NSAIDs but they're contraindicated and I ended up on pethedine and diamorphine. I was terrified until a fantastic anaesthetist sat me down and explained that pain and stress had been shown to cause growth retardation, whereas the medication would have minimal if any effect.
As a precaution I was transferred to a larger hospital before being induced early at 37 weeks, because our local little hospital didn't have a scbu. She was born at 7lb13oz, had a quick look over by the paediatrician and that was all, she didn't have any withdrawal or anything.

Taking painkillers if you need them is actually better for your baby!