The Main Changes in Pregnancy-Therapeutic Approach to Musculoskeletal Pain

Abstract

Background and Objectives: During pregnancy, women undergo various physiological and anatomical changes that are accentuated as the pregnancy progresses, but return to their previous state a few weeks/months after the pregnancy. However, a targeted therapeutic approach is needed. Most of the time, during this period, these changes precipitate the appearance of pain, musculoskeletal pain being the most common. Pregnant women should avoid treating musculoskeletal pain with medication and should choose alternative and complementary methods. Exercise along with rest is the basis for treating chronic musculoskeletal pain. Side effects of physical therapy are rare and, in addition, it is not contraindicated in pregnant women. The benefits of this type of treatment in combating pain far outweigh the risks, being an easy way to improve quality of life. The objective of this article is to discuss the management of musculoskeletal pain during pregnancy, to identify the main musculoskeletal pain encountered in pregnant women along with drug treatment, and to expose the beneficial effects of alternative and complementary methods in combating pain. Materials and Methods: A literature search was conducted using medical databases, including PubMed, Google Scholar, and ScienceDirect, using the keywords "changes of pregnancy", "musculoskeletal pain", "pregnancy pain", "pain management", "pharmacological approach", "alternative and complementary treatment" and specific sites. Information was collected from studies whose target population included pregnant women who complained of musculoskeletal pain during the 9 months of pregnancy; pregnant women with other pathologies that could increase their pain were not included in this review. Results: The articles related to the most common non-obstetric musculoskeletal pain in pregnancy along with pharmacological treatment options and alternative and complementary methods for musculoskeletal pain management during pregnancy were selected. Conclusions: The results were used to guide information towards the safest methods of therapy but also to raise awareness of the treatment criteria in order to compare the effectiveness of existing methods. Treatment must consider the implications for the mother and fetus, optimizing non-pharmacological therapeutic options.

Keywords: changes of pregnancy; musculoskeletal pain; pregnancy; treatment.

Figure 1

The main physiological and anatomical changes of pregnancy. (↑—increase, ↓—decrease).

Figure 2

Postural changes in pregnant women.

Figure 3

Acetaminophen exposure in potential pregnancy-associated effects observed in human studies. (↑—increase, ↓—decrease).

Figure 4

Chemical structures of non-steroidal anti-inflammatory agents: (a) aspirin, (b) ibuprofen, (c) diclofenac, (d) naproxen and (e) celecoxib.

Figure 5

Chemical structure of opioids: (a) codeine and (b) fentanyl.

Figure 6

Pharmacological and non-pharmacological treatment of pain in pregnant women.