Diclofenac is a non-steroidal anti-inflammatory drug (NSAID). In single doses it is used for mild to moderate pain but it is also used regularly as an anti-inflammatory medication which is often particularly effective in PGP. Diclofenac usually starts to work after about an hour, with the duration of action depending on the preparation used. It is available as tablets, slow-release tablets and suppositories (which may sound unpleasant but are acceptable and very effective). It is not usually used in the last trimester months of pregnancy owing to effects on the foetus. Small amounts are passed into breast milk but adverse effects are unlikely and it is commonly used on maternity wards after delivery. Naproxen and ketoprofen are possible alternatives as they are both in the same class of drugs.
Tramadol is indicated for moderate to severe pain, but its use in pregnancy and breastfeeding is not advised although it is often prescribed by consultants during pregnancy.
Opiate patches are starting to be more commonly used, particularly through pain clinics, for example, buprenorphine (Transtec®).
Nefopam is a non-opioid analgesic. The way that it works is not fully understood but it can be used to treat moderate pain. It is not recommended in pregnancy or when breastfeeding.
An injection may be used to temporarily block the nerve carrying the pain message, and it can also be used to help diagnose the causes of chronic pain. However, this is generally not very useful in PGP as it does not treat the cause of the problem, only the symptoms, and as it is an injection, it is invasive. If it is being offered, it is worth thinking again about whether you are really receiving the most effective manual therapy possible and whether a second opinion might give you a better result.
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