Pain Relief in Pregnancy: Exploring Alternatives

There’s ongoing debate about acetaminophen use during pregnancy and the possible ties to autism and attention deficit hyperactivity disorder (ADHD). Some studies suggest a connection, but most experts say we need more evidence. Expect questions about other ways to manage pain.

For patients who prefer to avoid acetaminophen during pregnancy, you can discuss several nonpharmacological approaches to help with pregnancy-related pain. Osteopathic manipulation, when performed by a trained professional, offers modest relief for back pain and improves function. In studies, it was safely given for 20 minutes seven times during the third trimester. Acupuncture can also provide moderate relief for low back, pelvic, or pelvic girdle pain while improving daily functioning. It's generally safe at most acupuncture points when sterile needles are used – though you should caution patients against acupuncture at the SP6 point due to potential risks of early contractions and miscarriage. Reflexology is another option that can reduce pregnancy-related low back and pelvic pain when administered properly for 30 minutes weekly for 6 weeks. Notably, most studies for these approaches were limited and small in size.

But what about patients who want something more readily available without needing to make another appointment?

That’s where capsicum might come in. Topical capsicum is FDA-approved for chronic pain and has demonstrated temporary pain relief for various conditions including back pain, neuropathic conditions, osteoarthritis, and psoriasis. It also appears to be beneficial for acute pain from injuries. Capsicum, applied topically or taken orally, appears to be safe during pregnancy. For example, studies have used oral doses of 5 mg daily for up to 28 days in the later months of pregnancy.

When discussing these alternatives, make sure to counsel patients on supplements for pain that aren’t safe during pregnancy. For instance, tell patients to avoid black mustard and turmeric - these may cause pregnancy loss or induce menstrual bleeding.

Always encourage patients to consult with you before trying pain relief strategies, as their specific pregnancy concerns may impact decision making. For additional evidence-based alternatives that may be safe in pregnancy, check out our “Pregnancy and Lactation Safety” tool to help patients make the most informed choices.