Many women suffering Complex Regional Pain Syndrome (CRPS) wish to start or add to their family. Whilst there are so many uncertainties surrounding CRPS, its causes and its effects on the body, there is no known reason why suffering CRPS should in itself make it more difficult to conceive.
Indeed, many women with CRPS do conceive and have healthy babies. There have even been cases reported of CRPS going into remission during pregnancy. However, there are a number of pregnancy and birth related issues that arise as a result of suffering CRPS.
A major consideration during pregnancy is the effect of both drugs and other therapies on the unborn child. Some drugs must be discontinued entirely for the duration of the pregnancy, others reduced. For some drugs, eg Gabapentin, there is simply insufficient research to determine whether or not they pose a significant risk during pregnancy.
In addition, for a mother considering breastfeeding, the use of certain drugs may continue to be problematic even after the birth of the baby.
There is no problem using a TENS machine during pregnancy. After all, they are commonly used as a means of pain relief in the early stages of labour. However, the jury remains out on the use of Spinal Cord Stimulators. Certainly, manufacturers do not encourage their use during pregnancy. On their website, Medtronic state “The safety and effectiveness of this therapy has not been established for…..pregnancy, unborn fetus, or delivery.”
There is some suggestion that the Electromagnetic Field (EMF) force generated by ‘stims’ may have some effect both on the ability to conceive in the first place and on the unborn child. Further, there is no current research on the long term effect on children who were exposed to higher levels of EMF in the womb.
Another practical issue with ‘stims’ is the risk of the subcutaneous leads moving as the abdomen expands during pregnancy.
Clearly, for anybody suffering CRPS who is considering having a baby, it is sensible to first consider a consultation with their pain specialist in order to discuss all of these issues.
Labour and Delivery
A common fear is that labour, delivery or even pregnancy itself, can aggravate CRPS or even precipitate its spread. There have been cases reported where CRPS in remission has recurred during pregnancy or shortly after the birth. As with so many aspects of CRPS, this simply highlights the unpredictability of the condition.
A detailed birth plan is essential and an expectant mother should satisfy herself that her obstetrician is fully acquainted with the condition, its risk factors and protocols. If a caesarean is a possibility, the usual surgical protocols should be adhered to unless the mother and/or baby’s life is in danger. Those protocols were considered in an earlier article.
Cases where CRPS has spread into the abdomen following a caesarean have been reported. However, as a result of the heightened risks to the underlying CRPS of a prolonged labour and/or the need for an episiotomy, obstetricians will often actively encourage a caesarean.
With a McGill Pain Index score higher than for childbirth, CRPS sufferers are no strangers to coping with extreme pain. This can be problematic at the start of labour as occasionally women suffering CRPS have failed to recognise the onset of contractions.
In terms of obstetric analgesia, most women with CRPS will opt for a spinal epidural and for those where their CRPS affects a lower limb or limbs, many report substantial or even total pain relief from their CRPS whilst the epidural is effective.
You may also be interested in the following articles:
Bernardini DJ, Pratt SD, Takoudes TC, Simopoulos TT. Spinal cord stimulation and the pregnant patient-specific considerations for management: A case series and review of the literature. Neuromodulation 2010;13:270-4
Journal of Obstetric Anaesthesia and Critical Care / Jul-Dec 2012 / Vol 2 | Issue 2
Poncelet C, Perdu M, Levi-Weil F, Philippe HJ, Nisand I. Reflex sympathetic dystrophy in pregnancy: Nine cases and a review of literature. Eur J Obstet Gynaecol Reprod Biol 1999;86:55-63.