Holistic Pain Management in Pregnancy : What RNs, APRNs, Midwives and Mental Health Professionals Need to Know

This book presents a patient centric, holistic view and management strategy for registered nurses, advanced practice nurses and midwives to care for the pregnant female, including considerations in pregnancy planning. There is a significant gap in information about holistic care and nursing considerations of the pregnant female with regards to pain management, which this book fills. It develops on the preparation before pregnancy, as nutrition or exercise, on behavioural management of pain with the impact of anxiety and different therapies. The book examines the musculoskeletal pain, the headache and fibromyalgia occurring during pregnancy. It also informs on the nutraceuticals in pregnancy, the use of opioids and of nerve blocks. This book finally explores complementary treatments during pregnancy. Case-studies are presented for improved understanding and to provide a real-world perspective. This book, written by nursing and psychology experts in their fields of specialty practice, will appeal to nurses and midwives working with pregnant women or planning to have a baby. Preface Contents 1: Introduction to Pain in Pregnancy 1.1 Summary References 2: Background and Medication Overview 2.1 Use of Opioids in Pregnancy 2.2 Non-opioid Pharmacotherapy 2.3 Acetaminophen/Paracetamol 2.4 Nonsteroidal Anti-inflammatory Drugs (NSAIDs) 2.5 Gabapentin 2.6 Pregabalin 2.7 Selective Serotonin Reuptake Inhibitors (SNRI) and Tricyclic Antidepressants (TCAs) 2.8 Low-Dose Naltrexone (1–5 mg/Daily) [68] 2.8.1 Low Dose Naltrexone in Pregnancy: Comparison of Outcomes Between Users and Nonusers During Pregnancy 2.9 OnabotulinumtoxinA (Botox) 2.10 Topicals (Aspirin, Menthol, Lidocaine, NSAIDS) 2.11 Melatonin 2.12 Summary References 3: Opioids and Opioid Use Disorder (OUD) in Pregnancy 3.1 Summary References 4: Nutrition and Microbiome: In Preparation for Pregnancy 4.1 Underlying Etiologies of Chronic Pain 4.2 Inflammation and Oxidative Stress Underlie Chronic Pain 4.3 Mitochondrial Function 4.4 Mitochondrial Function: Role in Chronic Pain 4.5 Mitochondrial Function and Pregnancy 4.6 Mitochondrial Function and Nutrition 4.7 Microbiome and Intestinal Barrier Function 4.8 Short-Chain Fatty Acid Essential Modulators of Inflammation and Neurology 4.9 Intestinal Barrier Function 4.10 The Role of Gluten in Intestinal Permeability and Chronic Pain 4.11 Dysbiosis 4.12 Microbiome and Pregnancy 4.13 Diet and the Microbiome 4.14 Remove Sugar, Gluten, Food Additives, and Pesticides 4.15 Replenish: Fiber, Prebiotics, and Polyphenols 4.16 Replace Fermented Foods, Fresh Produce, and Probiotics 4.17 Fresh Produce 4.18 Probiotics 4.19 Probiotics and Fibromyalgia 4.20 Probiotics and Pregnancy 4.21 Dietary and Supplemental Interventions for the Management of Chronic Pain 4.22 Diet and Pain 4.23 The Dietary Inflammatory Index (DII) 4.24 Supplements 4.25 Magnesium 4.26 Coenzyme Q10 4.27 Curcumin 4.28 Curcumin During Pregnancy 4.29 Vitamin D 4.30 Vitamin D and Pain 4.31 Sources of Vitamin D 4.32 Vitamin D Serum Status and Recommendations for Testing 4.33 Recommended Intake 4.34 Sun Exposure 4.35 Pregnancy 4.36 Vitamin D Dosing During Pregnancy 4.37 Considerations for Vitamin D Supplementation 4.38 Polyunsaturated Fatty Acids: Omega-3 and Omega-6 4.39 PUFAs and Pain 4.40 Fish Intake Versus n − 3 Supplements 4.41 Pregnancy 4.42 Considerations Regarding Fish Oil Supplements 4.43 Summary 4.44 Resources References 5: Behavioral Management for Pain in Pregnancy 5.1 Making the Case for Psychological Interventions 5.2 The Gate Control Theory 5.3 The Biopsychosocial Model 5.4 Depression and Anxiety in Pregnancy 5.4.1 Depression 5.4.2 Anxiety 5.5 Overview of Mental Health Treatment in Pain Management 5.6 Evidence-Based Treatments 5.6.1 Cognitive Behavioral Therapy (CBT) 5.6.2 Acceptance and Commitment Therapy (ACT) 5.6.3 Mindfulness-Based Stress Reduction (MBSR) 5.6.4 Relaxation Training 5.6.5 Biofeedback 5.6.6 Hypnosis 5.7 Techniques That Nurses Can Use with Patients 5.7.1 Psychoeducation 5.7.2 Mindfulness Practices 5.7.3 Activity Pacing 5.8 Diaphragmatic Breathing 5.9 Resources 5.10 Conclusion 5.11 Case Study References 6: Musculoskeletal Pain during Pregnancy 6.1 Occurrence/Incidence 6.2 Diagnoses (Table 6.1) 6.2.1 Low Back and Pelvic Pain 6.2.2 Lumbopelvic Pain Features 6.2.3 Screening the Pelvic Floor 6.2.4 Lumbar Radiculopathy 6.2.5 Trochanteric Bursitis 6.2.6 Physical Exam Techniques 6.2.6.1 Red Flags and Supine Hypotensive Syndrome 6.2.7 Neuropathies 6.2.8 Diagnostic Testing 6.3 Treatments 6.3.1 Pharmaceutical 6.3.1.1 Injections 6.3.2 Non-pharmaceutical 6.3.2.1 Bracing 6.3.2.2 Manual Therapies 6.3.2.3 Neuropathies 6.3.3 Behavioral Management Therapies 6.3.4 Physical Therapy 6.3.4.1 What Does a Typical Pelvic Physical Therapy Treatment Session Look like (Box 6.1)? 6.3.4.2 Prehabilitation 6.3.4.3 Swimming 6.4 Practical Resources – Box 6.2 6.5 Clinical Considerations 6.6 Case Study: 34-Year-Old Pregnant Client with Pubic Pain at 31 Weeks of Gestation References 7: Migraine in Pregnancy 7.1 Occurrence/Incidence 7.2 Diagnosis 7.3 Treatment 7.4 Pharmaceutical 7.5 Symptomatic/Acute Treatment in Pregnancy 7.6 Preventative Treatments in Pregnancy 7.7 Non-pharmaceutical 7.7.1 Noninvasive Neuromodulation 7.8 Clinical/Nursing Considerations 7.9 Case Study 7.10 Summary 7.11 Resources References 8: Fibromyalgia/Generalized Body Pain during Pregnancy 8.1 Occurrence/Prevalence 8.2 Diagnosis 8.3 Treatments 8.4 Pharmaceutical 8.5 Non-pharmaceutical 8.6 Nursing/Clinical Considerations 8.7 Case Study 8.8 Summary 8.9 Resources References 9: Use of Nerve Blocks and Neuromodulation in Pregnancy 9.1 Summary References 10: Complementary Treatments in Pregnancy 10.1 Summary References Conclusion