Pharmacological treatment of pain in pregnancy

Aragão, Fábio Farias de; Tobias, Alexandro Ferraz

doi:10.5935/2595-0118.20190068

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REVIEW ARTICLES • BrJP 2 (4) • Oct-Dec 2019 • https://doi.org/10.5935/2595-0118.20190068 copy

Pharmacological treatment of pain in pregnancy

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND AND OBJECTIVES:

Non-obstetric causes of pain during pregnancy are very common and can be disabling if not treated properly. The objective of this study is to discuss the pharmacological treatment of pain during pregnancy with a focus on drug classification and pregnancy use, therapy options, teratogenicity, increased fetal malformations and gestational complications associated with the use of therapy

During pregnancy, the body goes through several anatomical and physiological changes. These changes can precipitate pain, which in some cases can lead to disability. In addition, pregnancy may exacerbate pre-existing painful conditions. The choice to prescribe a drug to a pregnant woman is difficult. The changes in the body of a pregnant woman influence drug absorption, distribution, metabolism, and excretion, and may alter the expected response.

CONCLUSION:

The risks and benefits of the drug for the mother and the child should be considered, weighing the risks of not treating the disease adequately during pregnancy.

Keywords:
Analgesic; Pain treatment; Pregnancy

Categories	Interpretation
A	Controlled studies show absent risk. Appropriate well-controlled studies in pregnant women show no risk to the fetus.
B	No evidence of risk in humans. Findings in animals had shown risk, but not in humans, or if adequate studies with humans have not been conducted, and the findings in animals were negative.
C	Risk cannot be excluded. There are no positive studies for fetal risk in humans and animals or no studies at all. However, the potential benefits justify the potential risk.
D	Positive evidence of risk. Data of Investigation or aftermarket release show risk to the fetus. Even though, the potential benefits may outweigh the risk.
X	Contraindicated in pregnancy. Animal and human studies, or reports on research or aftermarket release, have shown a fetal risk that is greater than the potential benefits.

Categories	Farmaceutiska Specialiteter i Sverige	Australian Drug Evaluation Committee
A	Drugs used by many pregnant women without evidence of fetal damage.	Drugs used by many pregnant women without evidence of fetal damage.
B	Data in humans are insufficient and limited; classification is based on animal data (by allocation in one of three subgroups B1, B2 or B3).	Data in humans are insufficient and limited; classification was based on animal data (by allocation in one of three subgroups B1, B2 or B3).
B1	Experiments in animals did not provide evidence of an increased incidence of fetal damage.	Experiments in animals did not provide evidence of an increased incidence of fetal damage.
B2	Studies in animals are insufficient.	Studies in animals are insufficient.
B3	Studies in animals have shown evidence of increased incidence of fetal damage, but the significance in humans is uncertain.	Studies in animals have shown evidence of increased incidence of fetal damage, but the significance in humans is uncertain.
C	Drugs that, due to their pharmacological effects, have caused or are suspected of having caused reproductive disorders that may involve risks to the fetus, not being directly teratogenic	Drugs that have caused or may be suspected of causing harmful effects on the human or newborn fetus without causing malformations. These effects may be reversible.
D	Animal and/or human data indicate an increased incidence of fetal malformations or other permanent damages in humans.	The drugs have caused, are suspected of having caused, or can be expected to cause an increased incidence of human fetal malformations or irreversible damages.
X	Does not apply	Drugs that have such a high risk of permanent fetal damage that they must not be used during pregnancy.

Pregnancy exposure record	If a pregnancy exposure record is available, this subsection should contain a statement of the existence of the record as well as contact information.
Risk summary	When drug use is contraindicated, this should be stated first. Risk statements shall be presented in the following order: Based on human data, based on animal data, based on pharmacology Human data are available: the risk summary should summarize the specific development of the outcome, its incidence, and the effects of dose, duration of exposure, and gestational exposure time. Animal data are available: labeling should summarize the findings in animals and describe the potential risk of any adverse outcome in humans. Affected species, time, dose, and results should be included. When the drug has a well-understood mechanism of action that may result in the adverse outcome(s) to the development associated with the drug, the risk summary should explain the mechanism of action and potential risks.
Clinical considerations	Requires titles, as relevant information is available, to: · Maternal and/or embryo/fetal risk associated with the disease · Dose adjustments during pregnancy and the postpartum period · Maternal adverse reactions · Fetal/neonatal adverse reactions · Labor
Data	. Human data: Labeling should describe adverse outcomes of development, adverse reactions, and other adverse effects and the types of studies or reports, number of individuals and duration of each study, exposure information, and limitation of data. . Animal data: labeling should describe study types, animal species, dose, duration and timing of exposure, presence or absence of maternal toxicity, and limitation of data.

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[1] Correspondence to: Av. Grande Oriente, 23 - Renascença, 65075-180 São Luís, MA, Brasil. E-mail: fabio.aragao30@gmail.com

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Pharmacological treatment of pain in pregnancy

ABSTRACT

BACKGROUND AND OBJECTIVES:

CONTENTS:

CONCLUSION: