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Chronic Pain Patients in the Labor and Delivery Unit 

Chronic Pain Patients in the Labor and Delivery Unit
Chapter:
Chronic Pain Patients in the Labor and Delivery Unit
Author(s):

Dmitri Souzdalnitski

, Syed Ali

, and Denis Snegovskikh

DOI:
10.1093/med/9780199349302.003.0010
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date: 19 August 2019

This chapter suggests that chronic pain is a common comorbidity in pregnancy which may affect maternal and fetal outcomes. Labor and delivery analgesia and postpartum pain management are challenging aspects of care among patients with chronic pain, a history of opioid dependence, or a history of substance abuse. Sudden discontinuation of maintenance treatment (buprenorphine or methadone) or use of partial opioid agonists-antagonists, which is common practice among other parturients, may cause intolerable pain or acute withdrawal. This in turn may contribute to preterm labor, fetal abnormalities, or fetal demise. These patients typically have a lower pain threshold and require administration of higher doses of opioids. This subsequently may compromise patient and fetal or newborn safety. A special plan of neonatal care and breastfeeding is important during hospital admission of opioid-dependent patients.

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