Cancer-Related Pain Management in Pregnancy-A Review

Abstract

Background: Cancer-related pain management in pregnant patients is a complex clinical challenge requiring a careful balance between effective maternal analgesia and fetal safety. The pathophysiology of cancer-related pain varies, necessitating a nuanced, individualized approach to treatment with careful consideration of maternal-fetal safety, and pharmacokinetics. Objectives: This review aims to explore safe and effective pharmacological and interventional strategies for managing cancer-related pain in pregnant patients while highlighting disparities in access to care. Design: A comprehensive literature review was conducted. A total of 4766 articles were identified, with 98 studies included for final analysis after exclusion. Setting/Subjects: Studies included pregnant individuals with various hematological and solid tumor malignancies across various community and academic settings. Measurements: Pain typology was categorized (nociceptive or neuropathic), with treatment options including commonly available over-the-counter medications, opioids, various neuropathic medications, and interventional pain management options. In addition to pharmacological efficacy and maternofetal safety profiles, interventional efficacy, and socio-cultural influences on care were also measured. Disparities in access to care were also analyzed. Results: Analgesic options in pregnancy include acetaminophen, opioids, certain neuropathic medications, with very cautious use of NSAIDs. Interventional methods-neuraxial anesthesia, nerve blocks, spinal cord stimulation-offer adjunctive benefit if done under ultrasound guidance, but fluoroscopy and radiation guided modalities are best avoided in pregnancy. Diverse populations often encountered significant barriers to adequate pain control. Conclusions: Optimal cancer pain management in pregnancy necessitates a multidisciplinary, and individually tailored approach. Enhancing clinical evidence, and ensuring culturally competent care are critical to improving outcomes in this patient population.

Keywords: cancer-related pain; interventional techniques; minority populations; pain management disparities; pharmacological agents.