Opioid dependence is an epidemic in the United States, and the percentage of pregnant women who are opioid dependent has increased dramatically in the last decade. Pain management, already a concern for intrapartum and postpartum care, is complicated in the context of opioid dependence. This clinical review surveys the literature on pain management in opioid-dependent pregnant women to summarize current consensus and evidence to guide clinical practice. Points of consensus for pain management in opioid-dependent pregnant women include continual opioid maintenance therapy throughout the pregnancy and the postpartum period; adequate management of acute pain; the contraindication of opioid agonist-antagonists for pain management; and the need for interdisciplinary teams using a multimodal approach to provide optimal care to opioid-dependent pregnant women.
Johns Hopkins University School of Nursing, Baltimore, Maryland (Ms Safley); and University of Maryland School of Medicine, Baltimore (Ms Swietlikowski).
Corresponding Author: Rebecca R. Safley, MSN, CNM, WHNP-BC, 525 N. Wolfe St, Baltimore, MD 21205 (firstname.lastname@example.org).
The authors thank Ms Carrie Price for her invaluable assistance and Ms Jan Kriebs for her support and encouragement.
Disclosure: Ms Safley's doctoral work is partially funded by the Robert Wood Johnson Foundation. The other authors have no funding to disclose.
Submitted for publication: October 15, 2016; accepted for publication: January 24, 2017.