The management of chronic pain in pregnancy

Key content Chronic pain is of increasing relevance in clinical practice and may affect a significant proportion of pregnant women. Effective management demands a balance between adequate pain control and minimisation of risks to the fetus. Chronic pain medicines have varying safety profiles with regard to teratogenicity, pregnancy outcomes and neonatal development. Management is not limited to pharmacological therapies, and it is important to be aware of non‐pharmacological options available as alternatives or adjuncts to drugs. While the management of chronic pain is multidisciplinary, obstetricians are central to management decisions in pregnancy, and they must be familiar with current evidence to provide safe care. Existing guidelines on chronic pain do not include pregnancy‐specific considerations. We present the current evidence on perinatal use of pain medicines and discuss how non‐pharmacological interventions may benefit pregnant women with chronic pain conditions. Learning objectives To be familiar with the pharmacological and non‐pharmacological approaches to chronic pain management and their use in pregnancy. To understand the available evidence on the safety of chronic pain medicines in the perinatal period. To understand non‐pharmacological interventions for chronic pain and how these may benefit pregnant women with chronic pain.