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

Published: 05/09/2023

Case 3

Ms Z presents to the pain clinic with a history of severe pain affecting many of her joints, but in particular her pelvic girdle and knees. She is known to have rheumatoid arthritis, is 28 weeks pregnant and has a high BMI. She also suffers from diabetes for which she is on oral medication. Her mood is low. This is the second pregnancy and she reports that her first pregnancy three years previously was very traumatic, with a long labour of over 24 hours ending up in an emergency caesarean section in the middle of the night. She reports that she had required psychological therapy subsequently as she had been diagnosed with post traumatic stress disorder. She remains under the care of the local rheumatology team who are reviewing her ongoing need for disease modifying antirheumatic drugs.

  1. What further questions would you like to ask?
  2. Who do you think she may benefit from seeing during and after her pregnancy?
  3. What is the role of physiotherapy in pregnancy? What is women’s health physiotherapy?
  4. Are TENS and Acupuncture safe to use in pregnancy?
  5. What is the definition of post traumatic stress disorder and how can it be managed?
  6. Does the diabetes have an impact on her pain management?