Background & Aims
It is well known that chronic pain disproportionately affects women, many of whom are of childbearing age. Chronic pain is complex, affecting every aspect of life including reproductive health (1). Pain management approaches often include pharmacological interventions; many of which are contraindicated in pregnancy. However, the reproductive risks of long-term medication use prior to pregnancy and their impact on fertility are poorly understood (2). While opioids use is known to pose risk to the unborn fetus, studies indicate that only 2% of women of reproductive age who filled opioid prescriptions also had a prescription for contraceptives (3). Additionally, more than 61% of pregnancies are unplanned, which indicates that holistic pain care inclusive of reproductive health, is critical. The aim of this study is to identify whether we are addressing reproductive health in women of childbearing age with chronic pain and using pain medications.
Methods
This is a pilot pragmatic, observational study that anonymously surveyed women aged 18-50 years who have a chronic pain diagnosis and who are seeking chronic pain management at a tertiary care chronic pain clinic. All women who met inclusion criteria were invited to participate in this study at the time of their clinical appointment, either via paper-based survey or through an electronic survey (Microsoft Forms) data capture. Participants completed a brief survey designed by the study team that queried: family planning, contraceptive use, pain with sexual intercourse, medication use, understanding of reproductive safety with medications used, discussions of chronic pain and medication use on pregnancy with a healthcare professional, and desired topics of education. Specific pain diagnosis was not recorded. This study was formally reviewed by institutional authorities at Women’s College Hospital and was deemed not to require Research Ethics Board approval.
Results
Participants (n=25) included women (Mage=35.76 year; SD=6.72 years). Sixty percent (n=15) reported that they want to have children in the future and 16% reported that they wanted to be pregnant within the next year. When discussing chronic pain with a pain physician, 96% (n=24) reported that they were not asked about family planning. All women (100%) reported that their physician did not discuss the impact of chronic pain on fertility or the impact of chronic pain medications on fertility. Additionally, 96% (n=24) reported that their physician did not discuss the risks of certain medications on an unborn fetus. Over half of the participants (52%) reported that they did not understand the reproductive safety of the medications they were on and another 32% reported that they “somewhat” understood this. From the 22 patients reporting taking medications, they were on a variety of classes of medications: opioids, NSAIDS, antiepileptic, antidepressants, ketamine, and cannabis.
Conclusions
Pain is complex and involves biopsychosocial-spiritual components that vary across the lifespan. For women of childbearing age, special consideration must be paid to the treatment of chronic pain due to the reproductive risks associated with chronic pain and medications. Furthermore, holistic pain care should consider reproductive health and value-based goals around reproduction. This pilot data shows that women of childbearing age have gaps in their care around chronic pain, medications, and pregnancy. All women reported that they did not get counselled on this topic. Participants made recommendations of the education that they would like to receive and included, for example, chronic pain and pain medications and the impact on reproduction. The results of this study warrant replication and a larger sample size, however, it is clear that patients who could potentially get pregnant would benefit from, and would like, more education from healthcare professionals.
References
(1)Jankiewicz, A., Fielder, A., & Warland, J. (2015). Chronic pain management in pregnancy: A review of the literature. Canadian Journal of Midwifery Research and Practice, 14(2), 35-42.
(2)Ray-Griffith, S.L., Wendel, M.P., Stowe, Z.N., & Magann, E.F. (2018). Chronic pain during pregnancy: a review of the literature. International Journal of Women’s Heath, 10, 153-164.
(3)Ray-Griffith, S.L., Chopra, D., Stowe, Z.N., & Martin, B.C. (2019). Claims for contraceptive services among young women filling chronic opioid prescriptions. Contraception, 99, 296-299.
Presenting Author
Brittany N. Rosenbloom
Poster Authors
Brittany Rosenbloom, PhD, CPsych
PhD
Women's College Hospital
Lead Author
Rachael Bosma
PhD
Women's College Hospital
Lead Author
Adriano Nella
MSc
Women's College Hospital
Lead Author
Karen Ng
BScPhm
Women's College Hospital
Lead Author
David Flamer
MD
Sinai Health
Lead Author
Tania Di Renna
TAPMI
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Abdominal and Pelvic Pain