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Pain Management in the Opioid-Dependent Pregnant Woman

Safley, Rebecca R. MSN, CNM, WHNP-BC; Swietlikowski, Jamie MS, CNM

The Journal of Perinatal & Neonatal Nursing: April/June 2017 - Volume 31 - Issue 2 - p 118–125
doi: 10.1097/JPN.0000000000000244
Feature Articles: Continuing Education

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 (

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.

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