Avoiding pain relief may cause stress

By Madeleine Speed

It could be more important to avoid the stress of long-term pain than to avoid using pain relief.

This article may be controversial but it takes the view that it could be more important to take pain relief with Pelvic Girdle Pain (PGP) than struggle on and experience a great deal of stress from trying to cope without intervention. If your reason for avoiding painkillers in pregnancy is the worry that doing so would be selfish because of possible effects on the baby, you might want to read on. This may be a contentious article but whatever your views on taking pain relief for PGP in pregnancy, do consider the ideas here afresh and see if you feel the same after reading it.

Pain in PGP can be very wearing, upsetting and tiring. It can make you feel as though you want to slow down, to avoid doing anything that can cause pain and so you find yourself walking on eggshells to avoid any discomfort. Everyone is different so it is quite possible that no two women will experience PGP in exactly the same way. Where one woman may have pain in her lower back and difficulty walking without discomfort, another woman may find that she is particularly sore at the front of her pelvis and experience an odd burning sensation there when she moves. Sometimes the pain may be very obvious and cause a sharp intake of breath and at other times it may be less obvious but ever present so it accompanies every task you do and zaps energy and your sense of humour. Despite differences, there are bound to be some aspects that most women share and for those with more severe symptoms of PGP, there are likely to be periods of pronounced pain around the pelvis and a loss of mobility.

Many women agonise about whether or not to take painkillers or any kind of medication when they are pregnant or breastfeeding. We worry about the implications for the unborn baby and some of us think about the dreadful realities of powerful drugs such as thalidomide which caused scandal in the 1960s. Nowadays, powerful new drugs are never tried out first time without extensive trials and never on pregnant women. However, we still worry about taking any drugs in case we are somehow ‘just being selfish’ and not considering the baby as a priority and we tend to assume that not taking anything is the best position to adopt. Women are often very hard on themselves both concerning what they have done and what they have failed to do, so it is no wonder that something as serious as taking medication during pregnancy to reduce pain in PGP should be another rod with which to beat ourselves. Of course, the most common painkillers have been in use for many years and are well understood. There may be some risks associated with medication but they are generally low-level (often the side effects are just unpleasant for you rather than dangerous for the baby – such as experiencing stomach pain or constipation). Discussing these with your doctor may help you to find options that pose very little risk if any to you or your baby and could make a significant difference to your wellbeing during pregnancy with PGP. However, there are still a lot of women who would prefer not to risk any implications of taking drugs during pregnancy however small these risks may appear.

For women who have severe PGP, considering pain relief might be a real benefit to your overall health. If pain relief helps you to sleep, to manage, to feel comfortable, prevents you getting over-tired because of the PGP and helps you to really care for yourself and enhance your well-being, then it must be worth considering, mustn’t it? Pain can become very stressful with severe PGP and even for those who are obtaining effective treatment for their symptoms, high levels of pain over a number of months (or even years) can take a toll on your health. It has been known for some time that stress can be bad for your health. Various studies, particularly in the last decade, have indicated that stress can have negative implications for a woman who is pregnant. Stress hormones such as adrenaline (which increases your heart rate and enhances energy supplies) and cortisol (which increases glucose in the blood stream) may be able cross the placenta and have longer term implications for the baby as it is growing up. Up until recent research, studies had involved animals with similar physiology to us and found that stress in animals during pregnancy affects the body’s stress response system and particularly the production of cortisol – when an animal becomes anxious, this hormone is pumped into the blood stream. This in the short term can be very helpful – e.g. helping to drive the animal to jump out of the way of a perceived danger. Over the longer term, the experience of stress is not so beneficial; it can cause detrimental effects by suppressing other functions that are not seen as vital during moments of danger (e.g. processes which govern digestion, reproduction and growth). The outcome of having cortisol, the main stress hormone, in the system for prolonged periods it that it can cause tiredness, failure to detect or react to dangers appropriately and even, it is claimed, lead to susceptibility to illness. What, apparently, was less easy to pin down was whether human exposure to stress was similar to that recorded in animals. In early 2000, various studies were being conducted that looked at stress in humans. Research in 2007, published in the journal Clinical Endocrinology showed that stress experienced by a woman during pregnancy can be detected by her baby and may have implications for the baby’s development (see article in The Guardian by Lucy Ward, Thurs-day 31st May 2007). Other research confirms these findings and builds on them, suggesting that maternal stress can affect the foetus, both in the early gestation period and into childhood.

Researchers have made tentative links between stressed mothers having children who are prone to stress while growing up, and another study suggested links between levels of cortisol in foetal blood and a slower development of the brain and even an effect on IQ levels in children. The aim of this article is not to worry mums by creating yet another potential trigger for guilt. Instead it is to argue to that pain relief may have some very real benefits for women coping with searing pelvic pain and associated discomfort over the months of their pregnancy and often beyond the birth of their babies. Those women who refuse to take any pain relief through pregnancy may find it very stressful coping with the pain and immobility of PGP to such an extent that they may be found to be carrying a great deal of the main stress hormone cortisol in their blood. The research findings suggest that exposure to cortisol in particular over a very long time can have implications for the mum but also very real implications for her baby. To avoid having stress hormones in the blood for very prolonged periods, a mum with PGP may really benefit from taking pain relief regularly during the pregnancy and particularly at night. Using appropriate medication may help her relax, avoid producing large amounts of cortisol and generally increase her sense of well-being.

Everyone is different and no-one wants to encourage women to take any action during pregnancy with which they do not feel comfortable. Yet this new research does need to be considered dispassionately and weighed in the balance. Traditionally, women have assumed that they can do a lot of damage by taking pain relief during pregnancy. However, this new research suggests the reverse – that we may be doing damage to ourselves and our babies if we don’t take pain relief and instead battle on with pain and leave the stress hormones building up in our system. The key thing is to discuss the topic with your GP and find what works for you. The new research may be just the incentive pregnant women need to cast off any feelings of guilt and to use painkillers responsibly particularly if pain stops them sleeping at night.

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The Pelvic Partnership consists of volunteers who have had Pelvic Girdle Pain (PGP) and wish to support other women. We aim to pass on information based on both research and the experience of other women with PGP. We are not medical professionals and cannot offer medical advice and the information we provide should not take the place of advice and guidance from your own health-care providers. Material on this site is provided for information and support purposes only.

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