In Search of the Best Pain Clinic in LA: Pain and Pregnancy

By | January 24, 2012

Most pain clinics won't even see pregnant women.

A rare but interesting discriminant in our search for the best pain clinic in Los Angeles is the care of chronic pain during pregnancy. Traditional approaches to pain management all have serious deficiencies when dealing with the pregnant patient and many pain clinics will refuse to see pregnant women.

The most common, although in my opinion not the best form of treatment, for pain during pregnancy is oral opiates and probably the greatest database on narcotic therapy is our experience is with mothers enrolled in methadone maintenance programs. For the most part the babies are healthy and of normal size. The incidence of miscarriage and congenital anomalies is increased slightly, but given the patient population I am not sure what to say about this. The problem with this otherwise rosy picture comes from animal models where the offspring of rats given narcotics during gestation show mild to moderate behavioral changes and seem prone to what appears to be the rat equivalent of chronic neuropathic and central pain syndromes.

One of the first things that I do is to tell the patient that they are not alone and that they are not all that unusual. When I tell them that at Schlesinger Pain Centers I have treated many patients like them, I can see the fear and anxiety begin to melt away making further treatment possible.  Another key consideration in treating these patients is the self-limited nature of the complicating factor, i.e. the pregnancy. We do not need to cure the underlying condition. As I have said to these patients many times, ”My long-term plan is a series of short-term expediencies.” Using tricks borrowed from physical medicine and rehabilitation (PM&R) and occasionally from complimentary and alternative medicine (CAM) it is often possible to palliate their immediate pain.

Finally I tell them that great majority of pain syndromes in pregnancy as in non-pregnant states are cyclical. The natural history of these conditions is remissions and exacerbations with a periodicity of weeks to months. I tell them that if we can just get through the next couple of weeks the pain may improve spontaneously and that treatment may not be necessary throughout the pregnancy. In the following series of blogs we will look at how the best pain clinic in LA would deal with some of the more common chronic pain syndromes, back pain, neck pain and headaches in pregnant women.

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