pain medications in pregnancy

[oreosandsake]

did a search, did not find anything.

wondering thoughts for medications during pregnancy.

tylenol #3, sparing use of hydrocodone...?

what is okay for neuropathic pain?

we did some injections for SIJ during fellowship. are you all doing TPI? ESI?

do you use steroids, or local anesthetic only?

thanks

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[lobelsteve]

Have had 2 prego in 12 yrs. One had SIJ under US. MRI showed inflammatory reaction as sacroiliitis. Had Rheum work with me to use US.

Another chronic painer get kkocked up at 42. Cervical post lami on mscontin, percocet. Ssri and other meds from psych. I weaned off everything but 2 or 3 percocet per day. Healthy baby despite all this and smoking.

 

[kstarm]

There are some concerns for fetal birth defects with opioids. codiene in the first trimester or immediate pre-conception time for instance. The study that most often has been cited when looking at opioids causing fetal malformation was a retrospective one that had a number of potential flaws, and I believe that there has been studies on women on methadone maintenance that did not show an increase in fetal birth defects. I wasn't able to find that reference on my brief look. There is some info in the links below.


CDC on opioids and birth defects 2014
ACOG committee opinion on opioids (section on fetal birth defects) 2012
Prescription Opioids in Pregnancy and Birth Outcomes: A Review of the Literature-2015

 

[Stim4me]

LIDODERM, Tylenol, and tpi's... That's it and that's all for me. Tell them the progesterone and relaxin may palliate their pain...

 

[deleted185747]

If they are already on something when they get pregnant I would not change to something different because then the attorney doesn't know which medication to blame for the birth defect. If risks outweigh benefits then prescribe a taper of what she is already on. Don't try buprenorphine or codeine because it's safer because in this case its not.

 

[Ligament]

"Your attorney does not want me to treat your pain because he is going to sue me anytime in the next 18 years should there be anything medically wrong with your child. I'm sorry"

 

[oreosandsake]

"Your attorney does not want me to treat your pain because he is going to sue me anytime in the next 18 years should there be anything medically wrong with your child. I'm sorry"

thoughts on procedures, like TPI with 0.5-1% lidocaine?

we had done SIJ injections during fellowship under US in pregnancy. lidocaine and triamcinolone. not sure how much I want to do that now.

 

[bedrock]

thoughts on procedures, like TPI with 0.5-1% lidocaine?

we had done SIJ injections during fellowship under US in pregnancy. lidocaine and triamcinolone. not sure how much I want to do that now.

Only procedure I would do is TPI with saline.

Otherwise I won't touch a preggo, or prescribe them medications ever, unless I worked at the VA.

 

[SSdoc33]

TPIs with lido are fine. lets not go overboard, here.

i avoid any steroids, and basically any ora; medication. even tylenol has some questions lingering during pregnancy

 

[bedrock]

TPIs with lido are fine. lets not go overboard, here.

i avoid any steroids, and basically any ora; medication. even tylenol has some questions lingering during pregnancy

What life changing therapeutic effect does a TPI with lido accomplish over a TPI with saline?

 

[Doctodd]

PRP !!!!!! LMAO.....(and the crowd goes wild)

 

[SSdoc33]

What life changing therapeutic effect does a TPI with lido accomplish over a TPI with saline?

clearly, that is mischaracterization of my thoughts. there is rarely ever a life changing therapeutic affect with a TPI (or anything we do, really). i cant imagine how a TPI with PF lido makes you any more "sue-able" than a TPI with saline. you can still pop a lung. i think lido makes a TPI work a little better -- annecdotally

 

[nvrsumr]

I did carpal tunnel injections on pregos as a resident. Now pregnant or breastfeeding gets zero medications from me.

 

[lobelsteve]

I will work with their Ob. Would not start new meds, wean slowly on old meds, every note to Ob. Discussion over risks/benefits gets stuffed on every note.
Only seen 2 pregos since starting. Not wanting to see any more, but the risks are always overstated.
Go to an inner city hospital and watch meth/heroin addicts deliver 4-5 kids before turning 21, with none of the kids having medical problems or difficulties.

 

[SSdoc33]

I will work with their Ob. Would not start new meds, wean slowly on old meds, every note to Ob. Discussion over risks/benefits gets stuffed on every note.
Only seen 2 pregos since starting. Not wanting to see any more, but the risks are always overstated.
Go to an inner city hospital and watch meth/heroin addicts deliver 4-5 kids before turning 21, with none of the kids having medical problems or difficulties.

i thought you dont like annecdotes like this. actually, complications go WAY up without good prenatal care.

 

[Stim4me]

John Edwards Doctrine... Stay way from OB patients

 

[lobelsteve]

i thought you dont like annecdotes like this. actually, complications go WAY up without good prenatal care.

I hate these anecdotes. But i lack data. And sinve i never accept patients that are pregnant, i dont want to research it.

 

[bedrock]

clearly, that is mischaracterization of my thoughts. there is rarely ever a life changing therapeutic affect with a TPI (or anything we do, really). i cant imagine how a TPI with PF lido makes you any more "sue-able" than a TPI with saline. you can still pop a lung. i think lido makes a TPI work a little better -- annecdotally

It's just that 0.9% saline is considered a part of our body's natural chemistry and is regularly given IV, while lidocaine is technically a drug, , not a natural substance, and I won't give preggos any foreign substances some jerk lawyer can try to make a case about.

One might consider only dry needling for pregnant TPI.

 

[Stim4me]

It's just that 0.9% saline is considered a part of our body's natural chemistry and is regularly given IV, while lidocaine is technically a drug, , not a natural substance, and I won't give preggos any foreign substances some jerk lawyer can try to make a case about.

One might consider only dry needling for pregnant TPI.

Even acupuncture has been associated with premature labor, esp specific scapular points...

 

[bedrock]

Even acupuncture has been associated with premature labor, esp specific scapular points...

Wow, interesting.

That settles it. I'm never touching a pregnant woman, ever.

 

[Stim4me]

Wow, interesting.

That settles it. I'm never touching a pregnant woman, ever.

Yeah, they teach you at the Helms acupuncture course for physicians to avoid acup in preggies, esp certain meridian points.

 

[oreosandsake]

OK, thank you all.

1 more question - ESI in someone with HIV/AIDS?

corticosteroids? none? depends on CD4?

 

[lobelsteve]

OK, thank you all.

1 more question - ESI in someone with HIV/AIDS?

corticosteroids? none? depends on CD4?

I have a few, no issues with any procedure unless viral load up and CD4 under 500. But that is per ID who says yes or know.

 

[SSdoc33]

OK, thank you all.

1 more question - ESI in someone with HIV/AIDS?

corticosteroids? none? depends on CD4?

yeah, thats ok. unless newly diagnosed and way sick, but that seems more and more rare these days. btw, i am getting old.

 

[Doctodd]

Dont get old