Pain Treatment in Pregnancy: Pharmacological Approaches

Yıl 2024, , 157 - 163, 13.09.2024

Zeynep Tırmıkçıoğlu

https://doi.org/10.17942/sted.1195340

Öz

Although pain during pregnancy is caused by physiological changes, it can reach levels that can affect the daily life activity, sleep and work quality of the pregnant woman. If the pain lasts for a long time, it should be treated as it can lead to stress. An evidence-based approach to drug therapy during pregnancy is important for choosing the right drug and reducing fetal risk. It should be kept in mind that non-drug methods may not always be effective and safe in the treatment of pain. This article was written to provide information to both physicians and their patients about drugs that can be used in the treatment of acute and chronic pain during pregnancy. The concerns of the pregnant woman about the problems that she believes may occur during pregnancy due to drug use can be alleviated with accurate and sufficient information.

Anahtar Kelimeler

pregnancy, pain, drug therapy, teratogens

Gebelikte Ağrı Tedavisi: Farmakolojik Yaklaşımlar

Öz

Gebelikte ağrı, fizyolojik değişimler sonucu oluşmuş olsa da gebenin günlük yaşam aktivitesini, uyku ve çalışma kalitesini etkileyebilecek düzeylere gelebilir. Uzun sürdüğü takdirde strese de yol açabileceğinden tedavi edilmesi gerekir. Gebelikte ilaçla tedavide kanıta dayalı bir yaklaşım, doğru ilacın seçilmesi ve fetal riskin azaltılması açısından önemlidir. Ağrı tedavisinde ilaç dışı yöntemlerin her zaman etkili ve güvenilir olmayabileceği akılda tutulmalıdır. Bu makale, gebelikte akut ve kronik ağrının tedavisinde kullanılabilecek ilaçlar hakkında hem hekim hem de hastalarına bilgi sağlamak amacıyla kaleme alınmıştır. Doğru ve yeterli bir bilgilendirme ile gebenin ilaç kullanımına bağlı gebelikte oluşabileceğine inandığı sorunlar hakkındaki kaygıları bir miktar azalabilir.

Anahtar Kelimeler

gebelik, ağrı, ilaç tedavisi, teratojenler

Kaynakça

• Fiat F, Merghes PE, Scurtu AD, Almajan Guta B, Dehelean CA, Varan N, et al. The main changes in pregnancy-therapeutic approach to musculoskeletal pain. Medicina (Kaunas). 2022;58(8):1115.
• Aegidius K, Zwart JA, Hagen K, Stovner L. The effect of pregnancy and parity on headache prevalence: The Head-HUNT study. Headache 2009;49:851.
• Contag SA, Bushnell C. Contemporary management of migrainous disorders in pregnancy. Curr Opin Obstet Gynecol 2010;22:437.
• Puledda F, Silva EM, Suwanlaong K, Goadsby PJ. Migraine: from pathophysiology to treatment. J Neurol. 2023;270(7):3654-66.
• Raffaelli B, Lange KS. Migräne und Schwangerschaft : Geschlechtsspezifische Aspekte und aktuelles Wissen [Migraine and pregnancy: Gender-specific aspects and current knowledge]. Nervenarzt. 2024;95(4):308-15.
• Nappi RE, Albani F, Sances G, Terreno E, Brambilla E, Polatti F. Headaches during pregnancy. Curr Pain Headache Rep. 2011;15:289–94.
• Negro A, Delaruelle Z, Ivanova TA, Khan S, Ornello R, Raffaelli B, Terrin A, et al. Headache and pregnancy: A systematic review. J Headache Pain 2017;18(1):106.
• Rasmussen BK. Migraine and tension-type headache in a general population: precipitating factors, female hormones, sleep pattern and relation to lifestyle. Pain 1993;53(1):65-72.
• Morgan M. Challenging infections in pregnancy. Obstet Gynaecol Reprod Med. 2020;30(9):289-97.
• Gilo NB, Amini D, Landy HJ. Appendicitis and cholecystitis in pregnancy. Clin Obstet Gynecol 2009;52:586- 96.
• Gooding MS, Evangelista V, Pereira L. Carpal tunnel syndrome and meralgia paresthetica in pregnancy. Obstet Gynecol Surv. 2020;75(2):121-6.
• Klotz U. Paracetamol (acetaminophen) - a popular and widely used nonopioid analgesic. Arzneimittelforschung. 2012;62(8):355-9.
• Rebordosa C, Kogevinas M, Sorensen HT, Olsen J. Prenatal exposure to paracetamol and risk of wheezing and asthma in children: a birth cohort study. Int J Epidemiol 2008;37:583–90.
• Garcia-Marcos L, Sanchez-Solis M, Perez-Fernandez V, Pastor-Vivero MD, Mondejar-Lopez P, Valverde-Molina J. Is the effect of prenatal paracetamol exposure on wheezing in preschool children modified by asthma in the mother? Int Arch Allergy Immunol. 2008;149:33–7.
• Liew Z, Yuan Y, Meng Q, von Ehrenstein OS, Cui X, Flores MES, et al. Prenatal exposure to acetaminophen and childhood asthmatic symptoms in a population-based cohort in Los Angeles, California. Int J Environ Res Public Health. 2021;18(19):10107.
• Kristensen DM, Hass U, Lesne L, Lottrup G, Jacobsen PR, Desdoits-Lethimonier C, et al. Intrauterine exposure to mild analgesics is a risk factor for development of male reproductive disorders in human and rat. Hum Reprod. 2011;26(1):235-44.
• Jensen MS, Rebordosa C, Thulstrup AM, Toft G, Sorensen HT, Bonde JP, et al. Maternal use of acetaminophen, ibuprofen, and acetylsalicylic acid during pregnancy and risk of cryptorchidism. Epidemiology 2010;21:779-85.
• Fisher BG, Thankamony A, Hughes IA, Ong KK, Dunger DB, Acerini CL. Prenatal paracetamol exposure is associated with shorter anogenital distance in male infants. Hum Reprod. 2016;31(11):2642-50.
• Stergiakouli E, Thapar A, Smith GD. Association of acetaminophen use during pregnancy with behavioral problems in childhood. JAMA Pediatrics 2016;170(10):964-70.
• Avella-Garcia CB, Julvez J, Fortuny J, Rebordosa C, Garcia-Esteban R, Galan IR, et al. Acetaminophen use in pregnancy and neurodevelopment: Attention function and autism spectrum symptoms. Int J Epidemiol 2016;45(6):1987-96.
• Henderson JT, Whitlock EP, O’Connor E, Senger CA, Thompson JH, Rowland MG. Low-dose aspirin for prevention of morbidity and mortality from preeclampsia: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2014;160(10):695-703.
• Sun S, Qian H, Li C, Wang Q, Zhao A. Effect of low dose aspirin application during pregnancy on fetal congenital anomalies. BMC Pregnancy Childbirth. 2022;22(1):802.
• Couto AC, Ferreira JD, Pombo-de-Oliveira MS, Koifman S; Brazilian Collaborative Study Group of Infant Acute Leukemia. Pregnancy, maternal exposure to analgesic medicines, and leukemia in Brazilian children below 2 years of age. Eur J Cancer Prev. 2015;24(3):245-52.
• Sharpe CR, Franco EL. Use of dipyrone during pregnancy and risk of Wilms’ tumor. Brazilian Wilms’ Tumor Study Group. Epidemiology 1996;7:533-5.
• da Silva Dal Pizzol T, Schüler-Faccini L, Mengue SS, Fischer MI. Dipyrone use during pregnancy and adverse perinatal events. Arch Gynecol Obstet. 2009;279(3):293-7.
• Li DK, Liu L, Odouli R. Exposure to non-steroidalanti-inflammatory drugs during pregnancy and riskof miscarriage: Population based cohort study. BMJ 2003;327(7411):368.
• Daniel S, Koren G, Lunenfeld E, Bilenko N, Ratzon R, Levy A. Fetal exposure to nonsteroid anti-inflammatory drugs and spontaneous abortion. CMAJ 2014; 186: E177-E182.
• Campbell S, Clohessy A, O’Brien C, Higgins S, Higgins M, McAuliffe F. Fetal anhydramnios following maternal non-steroidal anti-inflammatory drug use in pregnancy. Obstet Med. 2017;10(2):93-5.
• Committee Opinion No. 711: Opioid use and opioid use disorder in pregnancy. Obstet Gynecol. 2017;130(2):e81-e94.
• Lind JN, Interrante JD, Ailes EC, Gilboa SM, Khan S, Frey MT, et al. Maternal use of opioids during pregnancy and congenital malformations: A systematic review. Pediatrics 2017;139(6):e20164131.
• Baldacchino A, Arbuckle K, Petrie DJ, McCowan C. Neurobehavioral consequences of chronic intrauterine opioid exposure in infants and preschool children: A systematic review and meta-analysis. BMC Psychiatry. 2014;8:14:104
• Dean L, Kane M. Codeine Therapy and CYP2D6 Genotype. In: Pratt VM, Scott SA, Pirmohamed M, Esquivel B, Kattman BL, Malheiro AJ, eds. Medical Genetics Summaries. Bethesda (MD): National Center for Biotechnology Information (US); September 20, 2012.
• Bromley RL, Weston J, Marson AG. Maternal use of antiepileptic agents during pregnancy and major congenital malformations in children. JAMA 2017;318:1700–1.
• Jentink J, Loane MA, Dolk H, Barisic I, Garne E, Morris JK, et al. Valproic acid monotherapy in pregnancy and major congenital malformations. N Engl J Med. 2010;362:2185–93.
• Huybrechts KF, Palmsten K, Avorn J, Cohen LS, Holmes LB, Franklin JM, et al. Antidepressant use in pregnancy and the risk of cardiac defects. N Engl J Med. 2014;370(25):2397-407.
• Smets K, Zecic A, Willems J. Ergotamine as a possible cause of Mobius sequence: Additional clinical observation. J Child Neurol 2004;19(5):398.
• Bérard A, Kori S. Dihydroergotamine (DHE) use during gestation and the risk of adverse pregnancy outcomes. Headache. 2012;52(7):1085-93.
• Demirel G, Oguz SS, Erdeve O, Dilmen U. Unilateral renal agenesis and urethral atresia associated with ergotamine intake during pregnancy. Ren Rail. 2012;34(5):643-4.
• Evans EW, Lorber KC. Use of 5-HT1 agonists in pregnancy. Ann Pharmacother. 2008;42(4):543-9.
• Marchenko A, Etwel F, Olutunfese O, Nickel C, Koren G, Nulman I. Pregnancy outcome following prenatal exposure to triptan medications: a meta-analysis. Headache 2015;55(4):490-501.
• Ozturk Z, Olmez E, Gurpinar T, Vural K. Pregnancy outcomes following the use of thiocolchicoside. Reprod Toxicol 2016;60:129-32.
• Cohen MM, Levy, Eliakim M. A cytogenetic evaluation of long-term therapy in the treatment of Familial Mediterranean fever (FMF). Am J Med Sci 1977;274:147-52.
• Yasar O, Iskender C, Kaymak O, Taflan Yaman S, Uygur D, Danisman N. Retrospective evaluation of pregnancy outcomes in women with familial Mediterranean fever. J Matern Fetal Neonatal Med 2014;27(7):733-6.
• Götestam SC, Hoeltzenbein M, Tincani A, Fischer-Betz R, Elefant E, Chambers C, et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis 2016;75:795–810.