Key result
Epidural opioids relieve severe back pain in a pregnant tetraplegic patient with mild neonatal withdrawal.
Why the study?
Management of severe low back pain with opioids during pregnancy in patients with incomplete tetraplegia is challenging and requires careful consideration of pain relief and neonatal risks.
Case Report (n=1)
Epidural opioid administration provided adequate pain relief for severe low back pain during pregnancy in a patient with tetraplegia, while minimizing neonatal withdrawal symptoms.
Answers are grounded in this paper and cite their sources.
May support epidural opioids for refractory pain in pregnant tetraplegics; case report leaves open need for prospective safety data.
We report a case of severe low back pain during pregnancy in a woman with incomplete tetraplegia due to viral myelitis. The pain was interpreted as a radiculopathy in the presence of multiple herniated discs. Surgical intervention was not indicated and physiotherapy failed; therefore, a symptomatic drug treatment with oral analgesics was initiated. To minimise the total daily opioid dosage and the potential risk of a neonatal withdrawal syndrome due to opioids, the route of administration was changed from oral to epidural. Adequate pain relief was maintained with this regimen until caesarean section was necessary. The neonatal withdrawal symptoms after delivery were mild. Residual pain slowly diminished after delivery and the patient was able to discontinue opioid therapy. The aetiology of low back pain remains unclear and may be multifactorial.
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Sabatowski et al. (2000) conducted a case report in Severe low back pain during pregnancy in a patient with incomplete tetraplegia (n=1). Epidural opioids vs. Oral analgesics was evaluated on Pain relief and neonatal withdrawal symptoms. Changing opioid administration from oral to epidural provided adequate pain relief for severe low back pain during pregnancy in a tetraplegic patient, with only mild neonatal withdrawal symptoms.
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