Pharmacologic pain management

While non-pharmacological methods are generally preferred, there are some cases where medication may be necessary to manage chronic pain during pregnancy. However, it is important to use medications under the strict guidance of a healthcare provider.

1. Acetaminophen (paracetamol)

Acetaminophen is considered one of the safest pain relievers during pregnancy when used in moderation. It is often recommended for headaches, muscle aches, and joint pain.

Important considerations:

• Should be used only as needed and in recommended doses.
• Prolonged or excessive use should be avoided due to potential risks.

2. Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs, such as ibuprofen and aspirin, are generally avoided during pregnancy, especially in the third trimester, because of the risk of complications for both the mother and the fetus.

Important considerations:

• The use of NSAIDs is discouraged, especially later in pregnancy.
• In early pregnancy, these drugs should be used only under medical supervision.

3. Opioids

Opioids are sometimes prescribed for severe, unmanageable pain, but their use during pregnancy is controversial because of the risk of addiction and neonatal abstinence syndrome (NAS) in newborns.

Important considerations:

• Should be used only for severe pain and under strict medical supervision.
• Risks and benefits should be carefully weighed.

Lifestyle and behavioral approaches

In addition to physical therapies and medical treatments, lifestyle changes and behavioral approaches can play a key role in managing chronic pain during pregnancy.

1. Getting enough sleep and rest

Sleep can be difficult during pregnancy, especially in the later stages. However, getting enough rest is essential for managing chronic pain. Using supportive pillows, especially for back and hip pain, can improve sleep quality.

Key tips:

• Use a pregnancy pillow to support your abdomen and hips.
• Sleep on your side, especially your left side, to improve circulation.

2. Healthy diet and hydration

Eating a healthy, balanced diet can help reduce inflammation and improve overall well-being, which can help relieve pain. Staying hydrated is also important to reduce muscle cramps and headaches.

Key tips:

• Focus on nutrient-rich foods such as fruits, vegetables, whole grains, and lean proteins.
• Stay hydrated to prevent muscle cramps and headaches.

3. Mindfulness and relaxation techniques

Mindfulness practices, such as meditation and deep breathing, can help manage chronic pain by reducing stress and promoting relaxation.

The benefits include:

• Reduces stress and anxiety.
• Promotes relaxation, which can help reduce pain levels.

Managing chronic pain during pregnancy is a delicate balance between the mother’s comfort and the baby’s health. Non-pharmacological methods, such as physical therapy, yoga, acupuncture, and massage therapy, are generally safe and effective options for pain relief. In more severe cases, certain medications, such as acetaminophen, may be used under medical supervision. In addition, lifestyle changes and behavioral approaches, including proper sleep, a healthy diet, and mindfulness, can also support pain management efforts.

If you’re pregnant and have chronic pain, talk to your healthcare provider about the best and safest ways to manage your pain during this special time.

Treatment options for tension-type headaches

Fortunately, there are several treatment options available, ranging from lifestyle changes to medical interventions. Here’s an overview:

Over-the-counter pain relievers

Simple analgesics: Medications such as acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or aspirin are often the first line of treatment. These medicines can be effective in relieving the pain associated with tension-type headaches.

Caution: It’s important to use these medications as directed to avoid overuse, which can lead to medication-overuse headache or other side effects.

Prescription medications

Muscle relaxants: In some cases, especially when over-the-counter options are ineffective, doctors may prescribe muscle relaxants. These can help relieve the muscle tension that contributes to these headaches.

Other prescription medications: For chronic tension-type headaches, your doctor may suggest other types of prescription medications, such as antidepressants or anti-anxiety medications. These are usually considered if the headaches are frequent or severe.

Interventional treatments for tension-type headaches

For people with chronic tension-type headaches for whom conventional treatments have limited effectiveness, interventional treatments may offer relief. These advanced methods focus on targeting the specific pain pathways involved in headaches. One such technique is nerve block injections, where anaesthetics are injected into specific nerves (such as the occipital nerves) to provide pain relief. Another option is trigger point injections, where pain-relieving medication is injected into specific areas of muscle tension or ‘trigger points’ that are thought to be the source of the headache. It’s important to note that these interventional treatments should only be considered under the guidance of a healthcare professional who specialises in pain management. They will assess the individual’s specific condition, determine the suitability of these approaches and ensure that they are carried out safely and effectively.

Treatment options for carpal tunnel syndrome include

Wrist splinting: Wearing a wrist splint can help reduce symptoms by keeping the wrist in a neutral position and relieving pressure on the median nerve.

Ergonomic changes: Adjusting your workstation to minimise wrist strain and maintain proper posture can help relieve symptoms.

Weight management: Losing weight if you are overweight or obese can reduce symptoms of carpal tunnel syndrome.

Breaks and rotations: Taking frequent breaks from repetitive activities involving the use of the hand and rotating the wrist can help prevent wrist strain.

Physical therapy: Exercises prescribed by a physiotherapist can help improve flexibility and strength in the wrist and hand, which may reduce symptoms.

Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen or naproxen sodium, and oral corticosteroids can help reduce inflammation and swelling and relieve stress on the median nerve. However, oral corticosteroids are not considered to be as effective as corticosteroid injections.

Corticosteroid injections: Injecting a corticosteroid, such as cortisone, into the carpal tunnel may relieve pain and inflammation. Local corticosteroid injections have been shown to result in greater clinical improvement after one month compared with a placebo.

Surgery may be recommended for patients with persistent or severe symptoms after trying non-surgical options. There are two types of carpal tunnel surgery: open surgery and endoscopic surgery.

Carpal tunnel syndrome is a common condition that can have a significant impact on daily life, particularly for those who perform repetitive hand movements. Early recognition of symptoms and appropriate management are essential for effective treatment. Whether through lifestyle changes or surgical intervention, seeking timely medical advice can help individuals regain comfort and functionality in their hands. If you suspect you may be experiencing symptoms of carpal tunnel syndrome, consult a healthcare professional to explore appropriate treatment options tailored to your specific needs.

Interventional therapies

Nerve blocks: Pudendal nerve blocks, which involve injections of local anaesthetic and steroid medication, may provide relief for a few months.

Pulsed radiofrequency ablation: Pulsed radiofrequency ablation has been used as an alternative to therapeutic pudendal nerve blocks and standard radiofrequency ablation. Studies have reported significant pain relief in a high percentage of patients treated with pulsed radiofrequency.

Botox injections: Botulinum toxin injections to relax the pelvic floor muscles and reduce pain.

Surgical procedures

Decompression surgery: Surgery to relieve pressure on the pudendal nerve.

Neuromodulation: Implantation of devices that modulate nerve activity to reduce pain signals.

Cognitive behavioural therapy (CBT)

CBT may be recommended for patients whose psychological effects are contributing to their chronic pain.

Lifestyle changes

Avoiding triggers: Identifying and avoiding activities that aggravate symptoms, such as prolonged sitting or cycling, and using therapeutic seat cushions.

Pelvic floor exercises: Strengthening exercises to improve pelvic muscle function and reduce pressure on the pudendal nerve.

Coping with pudendal neuralgia can be challenging, but a thorough understanding of the condition and its treatment options can empower individuals to seek appropriate care. If you or someone you know is experiencing symptoms consistent with pudendal neuralgia, it is important to consult a healthcare professional for an accurate diagnosis and personalised treatment plan. Remember that management of pudendal neuralgia often involves a combination of conservative and interventional therapies to improve overall quality of life.

Guided needle placement

Under fluoroscopic or ultrasound guidance, a specialised radiofrequency needle is inserted near the suprascapular nerve. The fluoroscope or ultrasound helps the physician visualise the placement of the needle in real time.

Radiofrequency ablation

Once the needle is correctly positioned, radiofrequency energy is delivered through the needle, generating heat that deactivates the nerve. This disrupts the nerve’s ability to transmit pain signals.

Post-procedure monitoring

After the procedure, patients are monitored for a short period to ensure there are no immediate complications or adverse reactions.

Complications of suprascapular nerve RF ablation

Complications associated with radiofrequency ablation of the suprascapular nerve are rare, but may include minor bleeding, infection, damage to nearby nerves, temporary pain or discomfort, allergic reactions, and weakness in the supraspinatus or infraspinatus muscles after the procedure.

Follow-up after the procedure

Usually, patients are discharged the same day as the procedure and can resume normal activities within a few days. Pain relief may take several weeks to become noticeable, and patients may require additional treatments in the future. Follow-up appointments with the treating physician are recommended to monitor the patient’s progress and ensure that there are no complications.

Suprascapular nerve radiofrequency ablation is a valuable option for patients suffering from chronic shoulder pain when conservative treatments have proven ineffective. This minimally invasive procedure can provide significant relief, improve quality of life and improve overall shoulder function. However, it is important for patients to consult with a healthcare professional to determine if they are a suitable candidate for this procedure and to receive personalised advice about the potential benefits and risks.

Medial branch nerve RF ablation procedure steps

Medial branch nerve blocks (diagnostic phase):

Before undergoing medial branch nerve radiofrequency denervation, patients often undergo a diagnostic phase to confirm the source of their pain. This phase usually consists of the following steps:

Initial assessment: Your healthcare provider will thoroughly review your medical history, perform a physical examination and review any previous imaging studies.

Imaging studies: X-rays, MRI or CT scans may be ordered to help determine the exact location of the source of pain, especially the facet joints in the spine.

Medial branch nerve block: A medial branch nerve block is used to confirm that the pain is coming from the medial branch nerves.

After the diagnostic medial branch nerve blocks, you will be observed for a short period to assess the degree of pain relief. If the diagnostic blocks provide significant relief (more than 50%), you may be considered a suitable candidate for the next stage, which is medial branch radiofrequency denervation.

Medial branch nerve RF ablation procedure

Pre-procedure preparation

Once you’ve been determined to be a candidate for the procedure, your physician will give you pre-procedure instructions. This will usually include instructions on fasting before the procedure, stopping certain medications (such as blood thinners), and arranging transportation to and from the medical facility.

You will have a peripheral vascular line inserted before the procedure and vital signs such as pulse rate, blood oxygen level and arterial blood pressure will be monitored once you are in the procedure room.

Positioning

Before the procedure begins, you’ll be positioned on the procedure table to allow access to the target area. Your healthcare provider will ensure that you are comfortable for the procedure and that you are positioned appropriately in the prone position. Specific positioning may vary depending on whether the medial branch nerve being treated is in the lumbar (lower back) or cervical (neck) region.