Case of the Month #31: Managing chronic pain during pregnancy

Published: 05/09/2023

Case 1

Ms X is a 27-year-old patient who presents with a history of chronic widespread pain and is also 30 weeks pregnant. She has a low body mass index of 18, with a history of long term drug misuse for which she has been taking Subutex (High dose buprenorphine) 16mg once daily for several months, under the auspices of the local drug addiction services. She denies any other current illicit drug use. The obstetricians have been monitoring her carefully as the baby appears to be showing signs of intra-uterine growth retardation. She complains bitterly of low lumbar back pain on top of her long standing widespread pain. She has no current partner and has not maintained contact with her baby’s father. 

  1. What other information would you like to know about her and why?
  2. What assessment measures/tools would you like to have?
  3. Who would you like to have involved in her anti and perinatal care?
  4. What are the risks of intrapartum use of buprenorphine?