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      Pharmacological treatment of pain in pregnancy Translated title: Tratamento farmacológico da dor na gestante

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          Abstract

          ABSTRACT BACKGROUND AND OBJECTIVES: Non-obstetric causes of pain during pregnancy are very common and can be disabling if not treated properly. The objective of this study is to discuss the pharmacological treatment of pain during pregnancy with a focus on drug classification and pregnancy use, therapy options, teratogenicity, increased fetal malformations and gestational complications associated with the use of therapy CONTENTS: During pregnancy, the body goes through several anatomical and physiological changes. These changes can precipitate pain, which in some cases can lead to disability. In addition, pregnancy may exacerbate pre-existing painful conditions. The choice to prescribe a drug to a pregnant woman is difficult. The changes in the body of a pregnant woman influence drug absorption, distribution, metabolism, and excretion, and may alter the expected response. CONCLUSION: The risks and benefits of the drug for the mother and the child should be considered, weighing the risks of not treating the disease adequately during pregnancy.

          Translated abstract

          RESUMO JUSTIFICATIVA E OBJETIVOS: As causas não obstétricas de dor durante a gravidez são muito comuns e podem ser incapacitantes se não forem tratadas adequadamente. O objetivo deste estudo foi discutir o tratamento farmacológico da dor durante o período gestacional com foco na classificação de fármacos e o uso na gravidez, opções de terapia, teratogenicidade, aumento de malformações fetais e complicações gestacionais associados ao uso da terapia. CONTEÚDO: Durante a gravidez, várias alterações anatômicas e fisiológicas ocorrem no corpo. Essas alterações podem precipitar a dor, que em alguns casos pode levar à incapacidade. Além disso, a gravidez pode exacerbar condições dolorosas pré-existentes. A escolha de prescrever um fármaco para uma gestante é difícil. As alterações gravídicas no corpo da gestante influem na absorção, distribuição, metabolismo e excreção dos fármacos, podendo alterar a resposta esperada. CONCLUSÃO: Deve-se considerar os riscos e benefícios do uso do fármaco para a mãe e filho, pesando-se os riscos de não tratar adequadamente a doença durante a gestação.

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          Most cited references52

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          Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain.

          Use of chronic opioid therapy for chronic noncancer pain has increased substantially. The American Pain Society and the American Academy of Pain Medicine commissioned a systematic review of the evidence on chronic opioid therapy for chronic noncancer pain and convened a multidisciplinary expert panel to review the evidence and formulate recommendations. Although evidence is limited, the expert panel concluded that chronic opioid therapy can be an effective therapy for carefully selected and monitored patients with chronic noncancer pain. However, opioids are also associated with potentially serious harms, including opioid-related adverse effects and outcomes related to the abuse potential of opioids. The recommendations presented in this document provide guidance on patient selection and risk stratification; informed consent and opioid management plans; initiation and titration of chronic opioid therapy; use of methadone; monitoring of patients on chronic opioid therapy; dose escalations, high-dose opioid therapy, opioid rotation, and indications for discontinuation of therapy; prevention and management of opioid-related adverse effects; driving and work safety; identifying a medical home and when to obtain consultation; management of breakthrough pain; chronic opioid therapy in pregnancy; and opioid-related policies. Safe and effective chronic opioid therapy for chronic noncancer pain requires clinical skills and knowledge in both the principles of opioid prescribing and on the assessment and management of risks associated with opioid abuse, addiction, and diversion. Although evidence is limited in many areas related to use of opioids for chronic noncancer pain, this guideline provides recommendations developed by a multidisciplinary expert panel after a systematic review of the evidence.
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            Antiplatelet agents for prevention of pre-eclampsia: a meta-analysis of individual patient data.

            Pre-eclampsia is a major cause of mortality and morbidity during pregnancy and childbirth. Antiplatelet agents, especially low-dose aspirin, might prevent or delay pre-eclampsia, and thereby improve outcome. Our aim was to assess the use of antiplatelet agents for the primary prevention of pre-eclampsia, and to explore which women are likely to benefit most. We did a meta-analysis of individual patient data from 32,217 women, and their 32,819 babies, recruited to 31 randomised trials of pre-eclampsia primary prevention. For women assigned to receive antiplatelet agents rather than control, the relative risk of developing pre-eclampsia was 0.90 (95% CI 0.84-0.97), of delivering before 34 weeks was 0.90 (0.83-0.98), and of having a pregnancy with a serious adverse outcome was 0.90 (0.85-0.96). Antiplatelet agents had no significant effect on the risk of death of the fetus or baby, having a small for gestational age infant, or bleeding events for either the women or their babies. No particular subgroup of women was substantially more or less likely to benefit from antiplatelet agents than any other. Antiplatelet agents during pregnancy are associated with moderate but consistent reductions in the relative risk of pre-eclampsia, of birth before 34 weeks' gestation, and of having a pregnancy with a serious adverse outcome.
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              Low-dose aspirin for prevention of morbidity and mortality from preeclampsia: a systematic evidence review for the U.S. Preventive Services Task Force.

              Preeclampsia is a leading cause of maternal and perinatal morbidity and mortality.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                brjp
                BrJP
                BrJP
                Sociedade Brasileira para o Estudo da Dor (São Paulo, SP, Brazil )
                2595-0118
                2595-3192
                December 2019
                : 2
                : 4
                : 374-380
                Affiliations
                [1] São Luís MA orgnameHospital e Maternidade Natus Lumine orgdiv1Clínica São Marcos orgdiv2Clínica de Dor Brasil
                [2] São Luís MA orgnameHospital e Maternidade Natus Lumine orgdiv1Clínica de Dor orgdiv2Departamento de Anestesiologia Brasil
                Article
                S2595-31922019000400374
                10.5935/2595-0118.20190068
                ef59e1a8-aa89-487f-ac32-e5f0df9b2624

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 14 December 2018
                : 28 February 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 58, Pages: 7
                Product

                SciELO Brazil

                Categories
                Review Articles

                Gestação,Pregnancy,Analgesic,Analgésicos,Tratamento da dor,Pain treatment

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