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

Published: 05/09/2023

Case 2

Ms Y is a 36 year old lady who is 22 weeks pregnant with her second child. She presents to the pain clinic with a long standing history of chronic back and radicular leg pain. She had undergone a microdiscectomy for a disc prolapse at L5/S1 six years previously. This was followed by a recurrent prolapse a year later for which she had a second spinal operation. Unfortunately her symptoms of radicular leg pain never settled as she developed epidural fibrosis. She had undergone conservative pain management which eventually culminated in insertion of a Dorsal Column Stimulator two years previously. This had been managing her symptoms fairly well although since she had become pregnant she was in a lot of pain again as her GP had instructed her to leave the device off until she was seen in the pain clinic and advised further.

  1. What other information would you like to know and why?
  2. What advice will you give her regarding her dorsal column stimulator?
  3. How do you manage the stimulator during the delivery?
  4. What would you advise if she requires a caesarean section?