Case of the Month #31: Managing chronic pain during pregnancy
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.
- What other information would you like to know and why?
- What advice will you give her regarding her dorsal column stimulator?
- How do you manage the stimulator during the delivery?
- What would you advise if she requires a caesarean section?