Pain Management Alternatives for Women

November 11, 2019

Gender differences based on culturally defined roles create unique issues for women with respect to pain and opioid addiction and misuse. A report issued earlier this summer by the U.S. Pain Management Best Practices Inter-Agency Task Force, “Pain Management Best Practices: Updates, Gaps, Inconsistencies, and Recommendations”, focuses on issues related to women as part of its extensive review of how acute and chronic pain are treated in this country.

The Task Force report indicates that women are more likely than men to misuse prescription opioids. Furthermore, from 1999 to 2010, the percentage increase in opioid-related overdose deaths was greater in women than in men. The report also discusses the pain management challenges associated with pregnancy and the potential adverse outcomes for newborns associated with opioid therapy. (e.g., Neonatal abstinence syndrome (NAS), a group of conditions caused by a baby withdrawing from opioids or other drugs they have been exposed to in the womb.) 

The Task Force suggests that pain care is not effectively delivered through a “one-size-fits-all” approach and makes several recommendations specific to women to improve pain management and mitigate heightened addiction risk. These recommendations include:

  • Increasing research to promote further understanding of the mechanisms driving sex differences in pain responses and of mechanism-based therapies that address those differences
  • Raising awareness in the public and healthcare arenas to the unique challenges that women face during pregnancy and in postpartum period, including various pain syndromes and psychosocial comorbidities
  • Including OB-GYNs as part of multidisciplinary care teams
  • Improving evidence for pain management of pregnant and postpartum women with greater research and innovation in collaboration with the national specialty societies (e.g., the American College of Obstetricians and Gynecologists, neonatologists, obstetricians, perinatal pediatricians, and other specialists)
  • Counseling women of childbearing age on the risks of opioids and non-opioid medications in pregnancy

Many patients who abuse prescription opioids trace their addiction to an initial exposure during an emergency department visit. Non-opioid based interventions using Ultrasound Guided Regional Anesthesia (USGRA) represent a safe and effective alternative to opioid treatments for acute and urgent care without the risk of addiction for women and newborns. These protocols include Alternative to Opioids in the Emergency Department (ALTO), Enhanced Recovery After Surgery (ERAS), and the Perioperative Surgical Medical Home.

Sonosite commends the Task Force for highlighting issues specific to women and for making important recommendations to improve pain management in this population. We also strongly support the Task Force recommendation calling for the adoption of non-opioid interventional pain management procedures when appropriate to address urgent and acute pain. Sonosite believes these protocols can provide a safe and beneficial alternative pain management methodology for women.