Journal of palliative medicine · 2025
Cancer-Related Pain Management in Pregnancy-A Review.
СтатьяОбзорНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Motiwala Zainab Yusufali, Raza Shahzad, Fernet Lucas Y, Kamal Faiza A, Misra Sidharth, Briceño Silva Gabriela D, Roy Tara, Anwer Faiz, Hamza Habib Muhammad
Аннотация
BACKGROUND: Cancer-related pain management in pregnant patients is a complex clinical challenge requiring a careful balance between effective maternal analgesia and fetal safety. The pathophysiology of cancer-related pain varies, necessitating a nuanced, individualized approach to treatment with careful consideration of maternal-fetal safety, and pharmacokinetics.
OBJECTIVES: This review aims to explore safe and effective pharmacological and interventional strategies for managing cancer-related pain in pregnant patients while highlighting disparities in access to care.
DESIGN: A comprehensive literature review was conducted. A total of 4766 articles were identified, with 98 studies included for final analysis after exclusion.
SETTING/SUBJECTS: Studies included pregnant individuals with various hematological and solid tumor malignancies across various community and academic settings.
MEASUREMENTS: Pain typology was categorized (nociceptive or neuropathic), with treatment options including commonly available over-the-counter medications, opioids, various neuropathic medications, and interventional pain management options. In addition to pharmacological efficacy and maternofetal safety profiles, interventional efficacy, and socio-cultural influences on care were also measured. Disparities in access to care were also analyzed.
RESULTS: Analgesic options in pregnancy include acetaminophen, opioids, certain neuropathic medications, with very cautious use of NSAIDs. Interventional methods-neuraxial anesthesia, nerve blocks, spinal cord stimulation-offer adjunctive benefit if done under ultrasound guidance, but fluoroscopy and radiation guided modalities are best avoided in pregnancy. Diverse populations often encountered significant barriers to adequate pain control.
CONCLUSIONS: Optimal cancer pain management in pregnancy necessitates a multidisciplinary, and individually tailored approach. Enhancing clinical evidence, and ensuring culturally competent care are critical to improving outcomes in this patient population.
OBJECTIVES: This review aims to explore safe and effective pharmacological and interventional strategies for managing cancer-related pain in pregnant patients while highlighting disparities in access to care.
DESIGN: A comprehensive literature review was conducted. A total of 4766 articles were identified, with 98 studies included for final analysis after exclusion.
SETTING/SUBJECTS: Studies included pregnant individuals with various hematological and solid tumor malignancies across various community and academic settings.
MEASUREMENTS: Pain typology was categorized (nociceptive or neuropathic), with treatment options including commonly available over-the-counter medications, opioids, various neuropathic medications, and interventional pain management options. In addition to pharmacological efficacy and maternofetal safety profiles, interventional efficacy, and socio-cultural influences on care were also measured. Disparities in access to care were also analyzed.
RESULTS: Analgesic options in pregnancy include acetaminophen, opioids, certain neuropathic medications, with very cautious use of NSAIDs. Interventional methods-neuraxial anesthesia, nerve blocks, spinal cord stimulation-offer adjunctive benefit if done under ultrasound guidance, but fluoroscopy and radiation guided modalities are best avoided in pregnancy. Diverse populations often encountered significant barriers to adequate pain control.
CONCLUSIONS: Optimal cancer pain management in pregnancy necessitates a multidisciplinary, and individually tailored approach. Enhancing clinical evidence, and ensuring culturally competent care are critical to improving outcomes in this patient population.