Tuesday, 28 July 2015

Pain medications in third trimester

As the third trimester approached I began to struggle as I was completely off of any and all pain medications. Trying to see how long I could go without them as in the third trimester it is suggested to try first to go on bed-rest and not have any medications as it's the best for the baby. My pain specialist has noted that understandably, I may need to go back on medications as pain causes stress to the body which is also bad for the baby. Thus, weighing all the research about my options, nortriptyline while unsafe in the first and second trimesters is now an option to go back to or doxepin. Yet, the least effective and least damaging would still be the Flexril and Extra Strength or T3 strengths of Tylenol as a combo. I've decided that at least with a low dose of nortriptyline (75mg) at least I know it will be effective, as the flexril/tylenol in the 1st and 2nd trimester was a joke, and trying something new like doxepin that's so closely related to the nortriptyline is a risk simply not worth taking at this stage.

However, all things considered I feel like I could manage the fibromyalgia in stride through on bed-rest but what I'm noticing to be most unbearable is the neuropathic pains. The fibromyalgia is predictable as I know where it will hurt, I know it will gradually flare and regularly hurt at increasing levels but the neuropathic is unpredictable. It comes randomly to differing locations and stays for differing durations, it's unpredictable and unbearable. I continue to look healthy and fine on the outside, as my appearance has never reflected the inside pain and sometimes, its quite upsetting as it makes me feel incongruent. Regardless of my pain level that ranges from 8/10-10/10 I reflect nothing on the outside; The surface level that everyone else sees feels like a lie, as it reflects a calm happy face when my insides have a war raging on. When the pain gets too bad to bear I calmly leave the room and go sit in the washroom where I don't need to smile and sometimes if I'm honest, I can't help but cry because its too much to bear alone. But, I suppose that's just life with this type of disorder, when it gets to heavy you take a time-out, leak out some tears, take a couple deep breathes, and eventually pull yourself together and return to life. Is there a better way?

Some people go all natural and unmedicated they swear by smoothie concoctions, natural health products, and vitamin supplements. All of which may help a mild case and may be good for fibromyalgia management, I have yet to discover one that helps my case of it. Yet I wonder what natural things are there for neuropathic pain?

  • B12 injection or supplements are said to help with general pain, also Zinc deficiency can cause pain. I've had the B12 injections during flares in pregnancy but it hasn't helped in any significant way. 
  • Neuropathy: The Northern California Chapter of the Neuropathy Association has published a guide to complementary and alternative treatments for neuropathy. Among the treatments listed are alpha-lipoic acid (a universal antioxidant), Bowen therapy (a type of massage) and IVIG (intravenous immunoglobulin therapy), as well as many folk remedies such as borage oil, primrose oil and nettle footbaths. Though there is little scientific evidence supporting these treatments, they are recommended anecdotally by members of NCCNA support groups. Be sure to always discuss alternative treatments with your doctor before experimenting with complementary therapies. 

What cures random electric shocks and sharp stabbing pain? Can we naturally cure this extreme? There are plenty of Dr.'s that continue to tell me how great it is that I'm pregnant as they say, "often pregnancy cures lupus, and fibromyalgia" they talk of pregnancy as a wonder drug in and of itself, that miraclously solves diseases that they can not explain. Does science really back up this claim I wonder?

The title above links to an article that was written by Dana Levy who notes how, "pregnancy and autoimmunity are a potentially hazardous combination. But with the right guidance and therapy, these women can become healthy mothers." As a question and answer with two Dr.'s (Michael Lockshin, MD, professor of medicine and obstetrics-gynecology at the Weill Medical College of Cornell University in New York City, and Laurence Mack, MD, an obstetrician/gynecologist with a special interest in high-risk obstetrics in Massapequa, N.Y. ) The article is a helpful resource for women with autoimmune disorders to understand the risks and benefits to pregnancy. As it relates to medication issues I have copied the question and answers directly below:

Q: Can a woman continue to take medication for an autoimmune condition while pregnant?

Dr. Lockshin: When women ask if it’s safe to stay on their medications, I say “I don’t know,” because there is no information available. Many medications have not been examined in pregnancy because drug companies don’t want to give experimental drugs to pregnant women. Often, the only data available are from animals. That said, cyclophosphamide and methotrexate are absolutely forbidden during pregnancy. Additionally, women should not use anti-inflammatory drugs in the latter stages of pregnancy because these agents can damage the baby’s heart and kidneys. In early pregnancy, however, these drugs are probably fine. We’re quite comfortable prescribing drugs like prednisone. With rheumatic diseases, we frequently prescribe hydroxychloroquine. 

Thyroid medications and insulin are also safe. There is some uncertainty about immunosuppressant drugs, but by and large, it is probably better for a woman to continue such medication and not risk a flare than to discontinue it. One of the worst scenarios occurs when a woman finds out she’s pregnant and stops her medications cold, only to have the disease explode.

Dr. Mack: We give pregnant women steroids, but we don’t like to prescribe high doses except in bursts. The strategy entails giving a burst and getting the autoimmune flare under control. Steroids should not be given on a chronic basis in high doses before 16 weeks’ gestation because they can cause congenital anomalies.

~Elysia B 


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