Cancer-Related Pain Management in Pregnancy-A Review.

Abstract

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. 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. A comprehensive literature review was conducted. A total of 4766 articles were identified, with 98 studies included for final analysis after exclusion. Studies included pregnant individuals with various hematological and solid tumor malignancies across various community and academic settings. 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. 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. 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.