Management of non-obstetric pain during pregnancy. Review article

  • Roberto Rivera Díaz Professor of Anesthesia and Pain Subspecialty, CES University, Colombian Institute of Pain, Medellín, Colombia
  • Adriana Lopera Rivera Anesthesia Resident, CES University, Medellín, Colombia
Keywords: Pain, Pregnancy, Labor, Acute pain, Analgesics

Abstract

Introduction: In pregnancy, women experience pain for reasons other than labor or delivery. Painful syndromes may occur during pregnancy, or chronic pain may become more acute, and patients should be offered treatment, always bearing in mind maternal and fetal safety.

Objective: To conduct a review of the scientific literature on the management of non-obstetric pain during pregnancy and the potential implications of the different pharmacological and interventional therapies available.

Materials and methods: Non-systematic review in the following databases: Medline, Pubmed, FDA and Drugs with a search of relevant articles in English.

Results: The articles related to the various types of therapies for pain management during pregnancy were selected.

Conclusion: The comprehensive approach to the management of conditions that may produce pain during pregnancy requires the use of medications that are not always 100% safe. Treatment must be inter-disciplinary and humanized, and consider the implications for the mother and fetus, optimizing, whenever possible, non-pharmacological therapeutic options.

References

1. Ertresvag JM, Zwart JA, Heide G, Johnsen HJ, Bovim G. Headache and transient focal neurological symptoms during pregnancy, a prospective cohort. Acta Neurol Scand. 2005;111:233-7.

2. Nappi RE, Albani F, Sances G, Terreno E, Brambilla E, Polatti F. Headaches during pregnancy. Curr Pain Headache Rep. 2011;15:289-94.

3. Contag SA, Bushnell C. Contemporary management of migrainous disorders in pregnancy. Curr Opin Obstet Gynecol. 2010;22:437-45.

4. Cassina M, Di Gianantonio E, Toldo I, Battistella PA, Clementi M. Migraine therapy during pregnancy and lactation. Expert Opin Drug Saf. 2010;9:937-48.

5. Pennick VE, Young G. Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database Syst Rev. 2007;2:CD001139.

6. Smith MW, Marcus PS, Wurtz LD. Orthopedic issues in pregnancy. Obstet Gynecol Surv. 2008;63:103-11.

7. Ostgaard HC, Andersson GB, Karlsson K. Prevalence of back pain in pregnancy. Spine (Phila Pa 1976). 1991;16:549-52.

8. Elden H, Ostgaard HC, Fagevik-Olsen M, Ladfors L, Hagberg H. Treatments of pelvic girdle pain in pregnant women: adverse effects of standard treatment, acupuncture and stabilising exercises on the pregnancy, mother, delivery and the fetus/neonate. BMC Complement Altern Med. 2008;8:34.

9. Noren L, Ostgaard S, Johansson G, Ostgaard HC. Lumbar back and posterior pelvic pain during pregnancy: a 3-year follow-up. Eur Spine J. 2002;11:267-71.

10. Vermani E, Mittal R, Weeks A. Pelvic girdle pain and low back pain in pregnancy: a review. Pain Pract. 2010;10:60-71.

11. Torstensson T, Lindgren A, Kristiansson P. Corticosteroid injection treatment to the ischiadic spine reduced pain in women with long-lasting sacral low back pain with onset during pregnancy: a randomized, double blind, controlled trial. Spine (Phila Pa 1976). 2009;34:2254-8.

12. Garmel SH, Guzelian GA, D'Alton JG, D'Alton ME. Lumbar disk disease in pregnancy. Obstet Gynecol. 1997;89 5 Pt 2:821-2.

13. Haanpaa ML, Gourlay GK, Kent JL, Miaskowski C, Raja SN, Schmader KE, et al. Treatment considerations for patients with neuropathic pain and other medical comorbidities. Mayo Clin Proc. 2010;85 Suppl 3:S15-25.

14. Shah RV. The management of nonobstetric pains in pregnancy. Reg Anesth Pain Med. 2003;28:362-3.

15. Pyke MR, Shutt LE. The management of non-obstetric pains in pregnancy. Reg Anesth Pain Med. 2003;28:54-7.

16. Ablove RH, Ablove TS. Prevalence of carpal tunnel syndrome in pregnant women. WMJ. 2009;108:194-6.

17. Turgut F, Cetinsahinahin M, Turgut M, Bolukbasi O. The management of carpal tunnel syndrome in pregnancy. J ClinNeurosci. 2001;8:332-4.

18. Hardy JB. The Collaborative Perinatal Project: lessons and legacy. Ann Epidemiol. 2003;13:303-11.

19. U.S. Food and Drug Administration. Summary of Proposed Rule on Pregnancy and Lactation Labeling, 2009 consultado 10 Dic 2011. Disponible en: http://www.fda.gov/Drugs/DevelopmentApprovalProcess/DevelopmentResources/Labeling/ucm093310.htm

20 Australian Department of Healt and Aging Therapeutic Goods Administration. Prescribing medicines in pregnancy database. 2011 consultado 1 Dic 2011. Disponible en: http://www.tga.gov.au/hp/medicines-pregnancy.htm

21. FDA U.S. Food and Drug administration. 2011 consultado 20 Sept 2011. Disponible en: www.fda.gov

22. Li DK, Liu L, Odouli R. Exposure to non-steroidal anti-inflammatory drugs during pregnancy and risk of miscarriage: population based cohort study. BMJ. 2003;327:368.

23. Arruza Gomez L, Corredera Sanchez A, Montalvo Montes J, De Marco Guilarte E, Moro Serrano M. Intrauterine closure of the ductus arteriosus probably associated with the taking of metamizole during the third trimester. An Pediatr (Barc).2008;68:626-7.

24. Bar-Oz B, Clementi M, Di Giantonio E, Greenberg R, Beer M, Merlob P, et al. Metamizol (dipyrone, optalgin) in pregnancy, is it safe? A prospective comparative study. Eur J Obstet Gynecol Reprod Biol. 2005;119:176-9.

25. da Silva Dal Pizzol T, Schuler-Faccini L, Mengue SS, Fischer MI. Dipyrone use during pregnancy and adverse perinatal events. Arch Gynecol Obstet. 2009;279:293-7.

26. Sharpe CR, Franco EL. Use of dipyrone during pregnancy and risk of Wilms' tumor. Brazilian Wilms' Tumor Study Group. Epidemiology. 1996;7:533-5.

27. Ives TJ, Tepper RS. Drug use in pregnancy and lactation. Prim Care. 1990;17:623-5.

28. Anderson J, Moor CC. Anti-epileptic drugs: a guide for the non-neurologist. Clin Med. 2010;10:54-8.

29. Pennell PB. Antiepileptic drugs during pregnancy: what is known and which AEDs seem to be safest?. Epilepsia. 2008;49 Suppl 9:43-55.

30. Jentink J, Loane MA, Dolk H, Barisic I, Garne E, Morris JK, et al. Valproic acid monotherapy in pregnancy and major congenital malformations. N Engl J Med. 2010;362: 2185-93.

31. Chong DJ, Bazil CW. Update on anticonvulsant drugs. Curr Neurol Neurosci Rep. 2010;10:308-18.

32. Hill DS, Wlodarczyk BJ, Palacios AM, Finnell RH. Teratogenic effects of antiepileptic drugs. Expert Rev Neurother. 2010;10:943-59.

33. Rose MA, Kam PC. Gabapentin: pharmacology and its use in pain management. Anaesthesia. 2002;57:451-62.

34. Marcus SM, Heringhausen JE. Depression in childbearing women: when depression complicates pregnancy. Prim Care. 2009;36:151-65.

35. Pariante CM, Seneviratne G, Howard L. Should we stop using tricyclic antidepressants in pregnancy? Psychol Med. 2010:1-3.

36. Flexeril drug information. 2007 consultado 20 Sept 2010. Disponible em: www.rxlist.com

37. Gentile S, Galbally M. Prenatal exposure to antidepressant medications and neurodevelopmental outcomes: A systematic review. J Affect Disord. 2011;128:1-9.

38. Scialli AR. Paroxetine exposure during pregnancy and cardiac malformations. Birth Defects Res A Clin Mol Teratol. 2010;88:175-7.

39. Einarson A. Antidepressants and pregnancy: complexities of producing evidence-based information. CMAJ. 2010;182:1017-8.

40. Hackley B. Antidepressant medication use in pregnancy. J Midwifery Womens Health. 2010;55:90-100.

41. American Society of Anesthesiologists Task Force on Chronic Pain Management, American Society of Regional Anesthesia and Pain Medicine. Practice guidelines for chronic pain management: an updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology. 2010;112:810-33.

42. NOUGG. Canadian guideline for safe and effective use of opioids in chronic non-cancer pain. 2010 consultado 8 Sept 2010. Disponible en: http://nationalpaincenter.mcmaster.ca/opioids/

43. Kakko J, Heilig M, Sarman I. Buprenorphine and methadone treatment of opiate dependence during pregnancy: comparison of fetal growth and neonatal outcomes in two consecutive case series. Drug Alcohol Depend. 2008;96:69-78.

44. Jones HE, Johnson RE, Jasinski DR, O'Grady KE, Chisholm CA, Choo RE, et al. Buprenorphine versus methadone in the treatment of pregnant opioid-dependent patients: effects on the neonatal abstinence syndrome. Drug Alcohol Depend. 2005;79:1-10.

45. Sharpe C, Kuschel C. Outcomes of infants born to mothers receiving methadone for pain management in pregnancy. Arch Dis Child Fetal Neonatal Ed. 2004;89:F33-6.

46. Collins LR, Hall RW, Dajani NK, Wendel PJ, Lowery CL, Kay HH. Prolonged morphine exposure in utero causes fetal and placental vasoconstriction: a case report. J Matern Fetal Neonatal Med. 2005;17:417-21.

47. Rathmell JP, Viscomi CM, Bernstein IM. Tratamiento del dolor durante el embarazo y la lactancia. En: Prithvi Raj P, editor. Tratamiento practico del dolor. 3.a ed. España: Harcourt; 2002. p. 205.

48. Cohen RS. Fentanyl transdermal analgesia during pregnancy and lactation. J Hum Lact. 2009;25:359-61.

49. Rathmell JP, Viscomi CM, Ashburn MA. Management of non-obstetric pain during pregnancy and lactation. Anesth Analg. 1997;85:1074-87.

50. Hagmeyer KO, Mauro LS, Mauro VF. Meperidine-related seizures associated with patient-controlled analgesia pumps. Ann Pharmacother. 1993;27:29-32.

51. Rosenberg L, Mitchell AA, Parsells JL, Pashayan H, Louik C, Shapiro S. Lack of relation of oral clefts to diazepam use during pregnancy. N Engl J Med. 1983;309:1282-5.

52. Hanson JL, Goodman EJ. Labor epidural placement in a woman with a cervical spinal cord stimulator. Int J Obstet Anesth. 2006;15:246-9.

53. Khan M, Mahmood T. Prolonged epidural analgesia for intractable lumbo-sacral pain in pregnancy. J Obstet Gynaecol. 2008;28:350-1.

54. Matsumoto E, Yoshimura K, Nakamura E, Hachisuga T, Kashimura M. The use of opioids in a pregnant woman with lumbar disc herniation: a case report. J Opioid Manag. 2009;5:379-82.

55. Desmond FA, Harmon D. Ultrasound-guided symphysis pubis injection in pregnancy. Anesth Analg. 2010;111:1329-30.

56. Bongiorni MG, Di Cori A, Soldati E, Zucchelli G, Segreti L, Solarino G, et al. Radiofrequency catheter ablation of atrioventricular nodal reciprocating tachycardia using intracardiac echocardiography in pregnancy. Europace.2008;10:1018-21.

57. Scicluna JK, Alderson JD, Webster VJ, Whiting P. Epidural analgesia for acute symphysis pubis dysfunction in the second trimester. Int J Obstet Anesth. 2004;13:50-2.

58. Mogren IM. Previous physical activity decreases the risk of low back pain and pelvic pain during pregnancy. Scand J Public Health. 2005;33:300-6.

59. Lile J, Perkins J, Hammer RL, Loubert PV. Diagnostic and management strategies for pregnant women with back pain. JAAPA. 2003;16:31-6, 38-39, 44.

60. Kihlstrand M, Stenman B, Nilsson S, Axelsson O. Water-gymnastics reduced the intensity of back/low back pain in pregnant women. Acta Obstet Gynecol Scand.1999;78:180-5.

61. Stuge B, Hilde G, Vollestad N. Physical therapy for pregnancy-related low back and pelvic pain: a systematic review. Acta Obstet Gynecol Scand. 2003;82:983-90.

62. Coldron Y, Crothers E, Haslam J. ACPWH guidance on the safe use of transcutaneous electrical nerve stimulation (TENS) for musculosketal pain during pregnancy. 2007 consultado 22 Sept 2009. Disponible en: http://www.oaa-anaes.ac.uk

63. Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database Syst Rev. 2008:CD003008.

64. Ternov NK, Grennert L, Aberg A, Algotsson L, Akeson J. Acupuncture for lower back and pelvic pain in late pregnancy: a retrospective report on 167 consecutive cases. Pain Med. 2001;2:204-7.

65. Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. Acupuncture for tension-type headache. Cochrane Database Syst Rev. 2009:CD007587.

66. Qerama E, Fuglsang-Frederiksen A, Jensen TS. The role of botulinum toxin in management of pain: an evidence-based review. Curr Opin Anaesthesiol. 2010;23:602-10.

67. de Oliveira Monteiro E. Botulinum toxin and pregnancy.Skinmed. 2006;5:308.

68. American Society of Health-System Pharmacists, Inc. Amitriptilyne Hidrochloride. 2011 consultado 23 Dic 2011. Disponible en: http://www.drugs.com/monograph/amitriptyline-hydrochloride.html

69. APP Pharmaceuticals L. Xylocaine. Prescribing Information. 2010 consultado 24 Dic 2011. Disponible en: www.accessdata.fda.gov/drugsatfda_docs/label/2010/006488s074lbl.pdf

70 Hospira Bupivacaine Hydrochloride 2011 consultado 24 Dic 2011. Disponible en: http://www.dailymedplus.com/monograph/view/setid/02a845c3-4521-4926-e397-25ab536e7cf6

71. Keltman Pharmaceuticals Inc. Flexeril. PrescribingInformation. 2010. consultado 23 Dic 2011. Disponible en: http://www.drugs.com/pro/flexeril.html

72 American Society of Health-System Pharmacists, IncBuprenorphine Hydrochloride. 2011 consultado 18 Dic 2011. Disponible en: http://www.drugs.com/monograph/buprenorphine-hydrochloride.html

73. GlaxoSmithKline. Wellbutrin. Prescribing information. 2011 consultado 10 Dic 2011. Disponible en: www.accessdata.fda.gov/drugsatfda.docs/label/2011/018644s043lbl.pdf

74. American Regent I. Caffeine citrate. Prescribing Information. 2011 consultado 13 Nov 2011. Disponible en: http://www.drugs.corn/pro/caffeine-citrate.html

75. Wolters Kluwer Health. Capsaicin. Prescribing Information. 2009 consultado 23 Oct 2011. Disponible en: http://www.drugs.com/ppa/capsaicin.html

76. Farkas R. Clinical Review, Adverse events. Drug: Carbamazepine. 2007 consultado 15 Mayo 2010. Disponible en: www.accessdata.fda.gov/drugsatfda_docs/nda/2007/016608s098,020712s029,021710_ClinRev.pdf

77. Teva Pharmaceuticals USA Inc. Clonazepam. Prescribing Information. 2011 consultado 25 Dic 2011. Disponible en: http://www.drugs.com/pro/clonazepam.html

78. Roxane Laboratories I. Codeine Sulfate. Prescribing Information. 2009 consultado 7 Oct 2011. Disponible en: http://www.drugs.com/pro/codeine-sulfate.html

79. Abbott Laboratories. Vicodin. Prescribing Information. 2011 consultado 10 Oct 2011. Disponible en: http://www.drugs.com/pro/vicodin.html#

80. Pfizer Laboratories Div Pfizer Inc. Dexamethasone Sodium Phosphate. 2011 consultado 12 Oct 2011. Disponible en: http://www.drugs.com/pro/dexamethasone-sodium-phosphate.html

81. American Society of Health-System Pharmacists, Inc. Diazepam. 2009 consultado 12 Oct 2011. Disponible en: http://www.drugs.com/monograph/diazepam.html

82. TEVA Pharmaceuticals USA Inc. Diclofenac. Prescribing Information. 2011 consultado 12 Oct 2011. Disponible en: http://www.drugs.com/pro/diclofenac.html

83. West-ward Pharmaceutical Corp. Ergotamine and Caffeine. Prescribing Information. 2008 consultado 12 Oct 2011. Disponible en: http://www.drugs.com/pro/ergotamine-and-caffeine.html

84. Eli Lilly and Company. Cymbalta. Prescribing Information. 2011 consultado 25 Dic 2011. Disponible en: www.fda.gov/Safety/MedWatch/SafetyInformation/ucm255064.htm

85. Cephalon I. Actiq. Prescribing Information. 2007 consultado 23 Dic 2011. Disponible en: www.fda.gov/downloads/Drugs/DrugSafety/ucm085817.pdf

86. Eli Lilly and Company. Prozac. Prescribing Information. 2009 consultado 28 Dic 2011. Disponible en: www.accessdata.fda.gov/drugsatfda_docs/label/2009/018936s075s077lbl.pdf

87. Pfizer. Dilantin. Medication guide. 2011 consultado 10 Ago 2011. Disponible en: www.fda.gov/downloads/Drugs/DrugSafety/UCM283845.pdf

88. Pfizer. Neurontin. Prescribing Information 2011 consultado 10 Agost 2011. Disponible en: www.accessdata.fda.gov/drugsatfda_docs/label/2011/020235s050,020882s035,021129s033lbl.pdf

89. Pfizer Inc. Lyrica. Medication guide. 2011 consultado 11 Marz 2012. Disponible en: www.fda.gov/downloads/Drugs/DrugSafety/UCM152825.pdf

90. Eli Lilly and Company. Zyprexa. Prescribing Information. 2008 consultado 25 Dic 2011. Disponible en: www.fda.gov/ohrms/dockets/ac/08/briefing/2008-4399b1-05%20(Zyprexa%20(olanzapine)%20Labeling).pdf

91 Purdue Pharma L P Dilaudid Prescribing Information 2011 consultado 10 Dic 2011. Disponible en: http://www.purduepharma.com/PI/prescription/DilaudidInjectionsPI.pdf

92. GlaxoSmithKline. Imitrex. Prescribing Information. 2010 consultado 10 Oct 2011. Disponible en: http://us.gsk.conyproducts/assets/us_imitrex_tablets.pdf.

93. Polygen Pharmaceuticals LLC. Ibuprofen. Prescribing Information. 2011 consultado 20 Oct 2011. Disponible en: http://www.drugs.com/pro/ibuprofen.html

94. Lupin Pharmaceuticals Inc. Imipramine Pamoate. Prescribing Information. 2011 consultado 20 Oct 2011. Disponible en: http://www.dmgs.corn/pro/imipramine-pamoate.html

95. West-ward Pharmaceutical Corp. Meperidine Prescribing Information. 2011 consultado 20 Oct 2011. Disponible en: http://www.drugs.com^pro/meperidine-injection.html

96. Hospira I. Naloxone. Prescribing Information. 2011 consultado 10 Oct 2011. Disponible en: http://www.drugs.com/pro/naloxone.html

97. H.J. Harkins Company I. Ketoprofen Prescribing Information.2011 consultado 20 Oct 2011. Disponible en: http://www.drugs.com/pro/ketoprofen.html

98. Teva Pharmaceuticals USA Inc. Lamotrigine. Prescribing Information. 2012 consultado 3 Oct 2011. Disponible en: http://www.drugs.com/pro/lamotrigine.html

99. Pfizer. Celecoxib, Capsules. Medication Guide. 2006 consultado 20 Dic 2011. Disponible en: http://www.fda.gov/downloads/Drugs/DevelopmentApprovalProcess/DevelopmentResources/UCM162532.pdf

100. Ascend Laboratories L. Methadone. Prescribing Information. 2012 consultado 23 Oct 2011. Disponible en: http://www.drugs.com/pro/methadone.html

101. Bedford Laboratories. Butorphanol Prescribing Information. 2010 consultado 10 Dic 2011. Disponible en: http://www.drugs.com/pro/butorphanol.html

102. West-ward Pharmaceutical Corp. Morphine. Prescribing Information. 2011 consultado 23 Oct 2011. Disponible en: http://www.drugs.com^pro/morphine-injection.html

103 Lupin Pharmaceuticals Inc Mefenamic Acid Prescribing Information 2011 consultado 12 Oct 2011. Disponible en: http://www.drugs.com^pro/mefenamic-acid.html

104 International Labs I Meloxicam Prescribing Information 2012 consultado 12 Dic 2011. Disponible en: http://www.drugs.com/pro/meloxicam.html

105 Roxane Laboratories I Naproxen Prescribing Information 2010 consultado 12 Oct 2011. Disponible en: http://www.dmgs.com/pro/naproxen.html

106 Himprit Pharmachem Pvt Ltd Aspirine Prescribing Information. 2010 consultado 12 Oct 2011. Disponible en: http://www.drugs.com/pro/aspirin.html

107. Breckenridge Pharmaceutical I. Oxcarbazepine. Prescribing Information. 2012 consultado 12 Oct 2011. Disponible en: http://www.drugs.com/pro/oxcarbazepine.html

108. Purdue Pharma L.P. OxyContin. Prescribing Information. 2010 consultado 23 Dic 2011. Disponible en: http://www.accessdata.fda.gov/drugsatfda_docs/label/2010/022272lbl.pdf

109 Acetaminophen information 2011 consultado 12 Oct 2011. Disponible en: www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm165107.htm

110. Teva Pharmaceuticals USA Inc. Piroxicam. Prescribing Information. 2011 consultado 23 Oct 2011. Disponible en: http://www.drugs.com/pro/piroxicam.html

111. Mylan Institutional Inc. Topiramate. Prescribing Information. 2011 consultado 14 Oct 2011. Disponible en: http://www.drugs.com/pro/topiramate.html

112. West-ward Pharmaceutical Corp. Flurazepam. Prescribing Information. 2010 consultado 19 Dic 2011. Disponible en: http://www.dmgs.com/pregnancy/flurazepam.html

113 Bioniche Pharma USA LLC Ultiva Prescribing Information 2009 consultado 10 Dic 2011. Disponible en: http://www.drugs.com/pro/ultiva.html

114. Pfizer. Zoloft. Prescribing Information. 2011 consultado 20 Dic 2011. Disponible en: http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/019839s072s075s076,020990s033s036s037lbl.pdf

115 Aurobindo Pharma Limited Divalproex Sodium Prescribing Information. 2011 consultado 12 Oct 2011. Disponible en: http://www.drugs.com/pro/divalproex.html

116. Wolters Kluwer Health. Quazepam. 2009 consultado 10 Dic 2011. Disponible en: http://www.dmgs.com/ppa/quazepam.html

117 Lachman Consultant Services Inc Tramadol Atachment C 2004 consultado 22 Dic 2011. Disponible en: www.fda.gov/ohrms/dockets/dailys/04/sep04/090804/04p-0405-cp00001-04-Attachment-C-vol1.pdf

118. Bristol-Myers Squibb Company. Kenalog. Prescribing Information. 2011 consultado 23 Dic 2011. Disponible en: http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/012041s038lbl.pdf

119. Pharmacia and Upjohn Company. Solu-Cortef Prescribing Information. 2010 consultado 20 Dic 2011. Disponible en: http://www.drugs.com/pro/solu-cortef.html

120. American Society of Health-System Pharmacists, Inc. Botulinum Toxin Type A. Prescribing Information. 2011 consultado 23 Dic 2011. Disponible en: http://www.drugs.com/monograph/botulinum-toxin-type-a.html

121. Pliva Inc. Valproic Acid. Prescribing Information. 2010 consultado 10 Dic 2011. Disponible en: http://www.drugs.com/pro/valproic-acid-capsules.html

122. Wyeth Pharmaceuticals Inc. Effexor. Prescribing information. 2006 consultado 23 Dic 2011. Disponible en: http://www.accessdata.fda.gov/drugsatfda_docs/label/2006/020151s044,020699s071lbl.pdf

123. Wyeth Pharmaceuticals Inc. Pristiq. Prescribing Information. 2009 consultado 22 Dic 2011. Disponible en: http://www.accessdata.fda.gov/drugsatfda_docs/label/2010/021992s017lbl.pdf

124. Wyeth Pharmaceuticals Inc. Inderal. Prescribing Information. 2011 consultado 22 Dic 2011. Disponible en: http://www.accessdata.fda.gov/drugsatfda_docs/label/2010/018031s036lbl.pdf

125. Novartis Pharmaceuticals Corporation. Lopressor. Prescribing Information. 2008 consultado 11 Marz 2012. Disponible en: http://www.accessdata.fda.gov/drugsatfda_docs/label/2008/017963s062,018704s021lbl.pdf

126 AstraZeneca Pharmaceuticals LP Tenoretic Prescribing Information. 2011 consultado 11 Marz 2012. Disponible en: http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/018760s028lbl.pdf
How to Cite
1.
Rivera Díaz R, Lopera Rivera A. Management of non-obstetric pain during pregnancy. Review article. Colomb. J. Anesthesiol. [Internet]. 2012Jul.1 [cited 2021Oct.16];40(3):213-2. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/415

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2012-07-01
How to Cite
1.
Rivera Díaz R, Lopera Rivera A. Management of non-obstetric pain during pregnancy. Review article. Colomb. J. Anesthesiol. [Internet]. 2012Jul.1 [cited 2021Oct.16];40(3):213-2. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/415
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