(sometimes called nociceptive pain)
This is often described as an aching, toothache-like pain, which is localised to the area affected.
The first route for pain relief is to discuss your pain with your GP or midwife. Pain relief is available to buy over the counter at your local pharmacy, but it is helpful to talk with your midwife or GP to make them aware that you have severe pain and that you need treatment. It is often a case of trial and error to find the treatment that suits you best, so do not be too downhearted if the first product you try does not help. Although PGP is a common condition, your GP may be relatively unfamiliar with its treatment and you may have to stress your need for pain relief if you have severe pain. Many people find that during pregnancy, GPs not used to managing PGP may be unwilling to prescribe anything stronger than paracetamol, in which case you can ask for a referral to a consultant (e.g. an obstetrician) who has more experience of pain management.
Be aware that taking painkillers regularly usually gives the best effect with chronic pain. However, if you take them regularly when you are not experiencing pain, your body may become accustomed to them, and they will become ineffective when you do experience pain.
These are the most commonly used drugs in PGP but don't be surprised if your doctor offers you something different. The more ‘traditional’ painkillers are used to treat this type of pain and the main groups of drugs used are paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs) and opioids.
NSAIDs and opioids
NSAIDs include ibuprofen (Neurofen™), which can be bought over the counter, diclofenac (Voltarol®) and naproxen (both on prescription). Again, if one doesn’t work it does not mean that another would not be effective, so it is well worth trying a number of different ones to see which suits you best. Diclofenac (Voltarol®) is commonly used to treat PGP and it is the only one recommended while breastfeeding. None is suitable for use in pregnancy.
Opioids are painkillers that come from the opium poppy or are closely related to it. They have been used for many years in controlling pain and act to mimic the production of endorphins, the body’s own natural painkillers. The opioids are usually classified into ‘weak’ and ‘strong’ groups, with the ‘weak’ opioids including codeine and dihydrocodeine and the ‘strong’ opioids including buprenorphine (Transtec® patches) and morphine. This classification can be a bit misleading as the so-called ‘weak’ opioids can be very effective for a variety of pains. Opioids are often used in combination with paracetamol and/or an NSAID, and this increases their effectiveness.
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