Complex Regional Pain Syndrome and Pregnancy Overview

There is very little information available on CRPS and pregnancy. The questions about pregnancy women have are answered by other women with CRPS who have been through it. I will give the information that is available about CRPS and pregnancy, and what I have heard from the women who have had successful pregnancies.

In Clinical Q&A: CRPS and Parenthood, an article by Joshua Prager, MD, MS, he talks about the effect of medications on the fetus during pregnancy. He states, "Most medications that are designed to treat either neuropathic pain or seizures can cause birth defects, including congenital anomalies, when taken during pregnancy. The fetus benefits from exposure to as few medications as possible. Talk with either an obstetrician or a neonatologist who is familiar with the effects of medication on embryo and fetal development."

Dr. Prager also says, "When the baby is born to a mother who has been taking opiates during the pregnancy, the child will go through withdrawal and be quite irritable for a short period of time. Intrauterine development, however, should not be affected by the opiates."

Finding a good doctor is vital during pregnancy when you have CRPS. If the doctor does not know anything about CRPS and pregnancy, he/she should be willing to learn. Every woman will have a different experience with pregnancy. Some go into remission and are pain free until after delivery. Others do not go into remission or they experience a worsening of CRPS pain.

During delivery there is a risk that having a cesarean section could cause spreading of CRPS into the abdomen, uterus and ovaries. A vaginal delivery could also cause CRPS to spread because of trauma to the tissue. The few women I know who have told their pregnancy and delivery stories on forums reported no spreading of CRPS with their vaginal deliveries. Though there is a risk of CRPS spreading, it does not mean there will be.

Dr. Prager has this to say about delivery, "We have recommended a cesarean section be performed under dense regional anesthesia in any patient who is at risk for a traumatic vaginal delivery. After this technique, one patient developed mild CRPS symptoms at the site of the cesarean section. The anesthesiologist who provided regional anesthesia for this delivery did not provide dense blockade for the surgery."

He adds, "The procedure described above is not part of any guideline, but we feel that it is a common sense approach to addressing potential traumatic delivery in CRPS patients. We are pleased with our results from this approach, but recommend that anyone considering delivery who has CRPS, frankly discuss the delivery issues with both the obstetrician and the anesthesiologist."

Part of labor and delivery involves starting an IV and having blood drawn. Ask to have the IV and any blood draws done on the arm that does not have CRPS. This would also include taking blood pressure so there is no flare up of CRPS. If both arms are affected, ask them to use small needles.

If a woman continues to experience CRPS pain while pregnant, she may not realize when she is having contractions. Carrie, whom I interviewed in a previous article, says, "I was in pre-term labor during both pregnancies about 19/20 weeks. I couldn't even feel the contractions and I had no clue that I was having them. The CRPS pain made the pain of the contractions feel like they weren't anything!" Not being able to feel contractions should be discussed with the doctor. Make a plan with him/her that covers any situations you may have while pregnant.

Each woman will have a unique experience with CRPS and pregnancy. They need to talk to their doctor and write up a detailed birth plan. This will ensure nothing is forgotten during the controlled chaos of labor and delivery.

Clinical Q & A: CRPS and Parenthood