Management of cancer pain in pregnancy: can opioids be used?

Cancer in pregnancy is less common, however its frequency is increasing due to delayed onset of childbearing. Pregnant patients with cancer can experience high frequency of moderate to severe cancer pain. It can be challenging to manage cancer pain due to the complexity with assessment and treatment as many of the analgesics are avoided. There exists limited research and few guidelines by national and international organizations to guide effective opioid management among pregnant women or pregnant woman with cancer pain. Pregnant patients with cancer need to be managed by interdisciplinary team with multimodal analgesia including opioids, adjuvants, non-pharmacological interventions for optimal care of these patient and later the neonate. Opioids such as morphine may be considered for the management of severe cancer pain during pregnancy. It is important to prescribe the lowest effective dose and quantity of opioids after taking into consideration the risk/benefit to patient-infant dyad. Neonatal abstinence syndrome should be anticipated after delivery and carefully managed in intensive care, if possible. Further research is needed. In this review article we describe the challenges of managing cancer pain in pregnant woman and the current approach of opioids management for cancer pain in these patients using a case report.