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Chronic Pain Management in Pregnancy
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Chronic Pain Management in Pregnancy
Chronic Pain Management in Pregnancy
Study
1
Question
What defines pain according to the International Association for the Study of Pain?
Page 1
Answer
An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.
2
Question
How long must pain persist to be classified as chronic?
Page 1
Answer
Beyond 3 months.
3
Question
What is the prevalence range of chronic pain in the UK population?
Page 1
Answer
Between one-third and half of the UK population.
4
Question
Why does the traditional WHO pain ladder not apply to chronic pain management?
Page 1
Answer
Chronic pain requires condition-specific assessment and a biopsychosocial approach.
5
Question
What proportion of pregnant women may have pre-existing chronic pain conditions?
Page 1
Answer
Up to 28%.
6
Question
How does chronic pain differ from acute pain in function and duration?
Page 2
Answer
Acute pain lasts under 3 months with adaptive protective role; chronic pain lasts beyond 3 months without adaptive function.
7
Question
What distinguishes chronic primary pain from secondary pain?
Page 2
Answer
Primary pain is a disease itself without evident cause; secondary pain arises from an underlying disease process.
8
Question
Name the three mechanisms by which pain is classified.
Page 2
Answer
Nociceptive, neuropathic, nociplastic.
9
Question
Which chronic pain conditions are most frequently encountered in pregnancy?
Page 2
Answer
Neck pain, back pain, headaches, pelvic pain, abdominal pain.
10
Question
What impacts does untreated chronic pain have on pregnant women?
Page 2
Answer
Anxiety, depression, sleep disturbance, reduced daily activities and newborn care ability.
11
Question
Why is research on pain medicines in pregnancy limited?
Page 2
Answer
Ethical concerns exclude pregnant women from randomized control trials.
12
Question
What does Figure 1 illustrate about pain classification?
Page 3
Answer
Primary versus secondary classification as outlined by ICD-11.
13
Question
When should non-pharmacological interventions be attempted in chronic pain management during pregnancy?
Page 3
Answer
Before drug therapy is considered, if appropriate.
14
Question
Which pharmacological agents are used to manage chronic pain?
Page 3
Answer
Simple analgesia, opioids, antidepressants, anticonvulsants.
15
Question
What is paracetamol used for in chronic pain?
Page 4
Answer
Mild-to-moderate acute pain, headaches, combination therapy in chronic low back pain.
16
Question
What are the key perinatal risks associated with NSAID use?
Page 4
Answer
First-trimester congenital anomalies, low birthweight, oligohydramnios, ductus arteriosus constriction.
17
Question
Under what conditions are opioids indicated for chronic pain in pregnancy?
Page 4
Answer
Time-limited for acute flares supplementary to non-pharmacological strategies; detoxification or replacement therapy.
18
Question
What evidence exists on first-trimester opioid exposure and congenital malformations?
Page 5
Answer
Meta-analysis shows no association with major malformations.
19
Question
Why is sumatriptan considered safe for migraine in pregnancy and breastfeeding?
Page 5
Answer
No significant association with malformations, low birthweight, preterm birth; limited breastmilk excretion.
20
Question
What are anti-neuropathic drugs used for in chronic pain?
Page 5
Answer
Consequence of somatosensory damage or some chronic primary pain conditions.
21
Question
What cardiovascular risk is associated with antenatal SSRI use?
Page 6
Answer
Increased malformations, but absolute risk low and confounded by depression.
22
Question
How do SNRIs compare to SSRIs in PPH risk during delivery?
Page 6
Answer
Higher risk with SNRI use than SSRIs.
23
Question
What malformation risks are linked to gabapentinoid exposure?
Page 7
Answer
Increased major and cardiac malformations; preterm birth, pre-eclampsia, small-for-gestational-age.
24
Question
Why restrict sodium valproate and carbamazepine in pregnancy?
Page 7
Answer
Major teratogens with dose-dependent congenital malformation risks.
25
Question
What NICE categories cover non-pharmacological chronic pain therapies?
Page 7
Answer
Psychological interventions, exercise, acupuncture.
26
Question
How does CBT address chronic pain according to Figure 2?
Page 8
Answer
Challenges unhelpful thoughts, promotes coping strategies, encourages adaptive behaviors.
27
Question
Is acupuncture safe and effective for pregnancy-related chronic pain?
Page 8
Answer
Yes, recommended by NICE for chronic pain management.
28
Question
What are pain management programmes (PMPs)?
Page 8
Answer
Structured multidisciplinary interventions improving quality of life and functioning via CBT, skills-training, exercise, education.
29
Question
Why is invasive neuromodulation controversial in pregnancy?
Page 8
Answer
Effects on fetal development, placental function, labour poorly understood.
30
Question
What general recommendations apply to all chronic primary pain conditions?
Page 9
Answer
Exercise/physical activity, psychological therapy, acupuncture, pharmacological therapy in no particular order.