Feature Article

Managing pain in pregnancy: some uncomfortable decisions

Michael Paech



Pain during pregnancy is complicated by diagnostic dilemmas, including different presentations due to physiological and anatomical changes, concerns about imaging, and therapeutic challenges because of contraindications and uncertainties about maternal and fetal drug safety.

Key Points

  • Pain during pregnancy is extremely common.
  • Spine and pelvic girdle musculoskeletal pain and nerve entrapment syndromes can present for the first time in pregnancy and other painful abdominal and pelvic visceral conditions occur more frequently during pregnancy.
  • Nonpharmacological therapies should be considered as initial treatment, together with analgesic drugs of established safety, prescribed in the lowest therapeutic dose for the shortest possible time.
  • All drug prescribing in pregnancy requires consideration of the risks to the fetus as well as the mother. These risks vary with gestational age, dose, duration of exposure and the specific drug.
  • GPs play a crucial role in the management of pain in pregnancy as a primary diagnostician or therapist, resource provider and adviser, or co-ordinator of care.

    Picture credit: © Maskot/Katja Kircher/