Pain During Pregnancy

Last Update: 06 Aug 2025

Condition

Table of content

1. What is it? 2. Why managing? 3. Non-Medical Options 4. Medications 5. Breastfeeding/ chestfeeding 6. Key Takeaways 7. Limits of Research

Welcome to our Fact Sheet on pain during pregnancy and breastfeeding or chestfeeding. The information is based on current research and may be updated as new scientific knowledge emerges. It’s important to remember that the content shared here does not replace personalized advice from healthcare professionals.

1. What is pain?

Pain can be difficult to describe as it’s often a symptom associated with other medical conditions (pre-existent or new). For example, pain can be associated with pregnancy, endometriosis, uterine fibroids, infections, rheumatoid arthritis, anxiety, and more.

Pain typically falls into two categories:

Nociceptive Pain: This occurs when pain receptors in the skin, bones, articulations, muscles, or organs are activated. This type of pain is often described as constant, deep, pressure-sensitive, worsens with movement, and is well-localized.

Neuropathic Pain: This results from nerve damage, often due to infections (like herpes) or conditions (like diabetes), and can be more difficult to treat. This pain usually feels like burning, tingling, sharp stabbing, or electric shocks.

In both cases, pain can be either acute (short-term) or chronic (lasting more than 3 months). Treatment depends on the type, location, and associated medical conditions. For details on pain associated with a known condition, you can consult the related condition fact sheets. For information specifically on headaches and migraines, please read our fact sheet here.

During pregnancy, a lot of pregnant individual experience new types of pain due to the body’s changes. Other than contractions and labor pain, lower back pain and pelvic pain are common, affecting about half of pregnant individual. This type of pain can start as early as week 10.

Lower back pain and pelvic pain is often caused by hormonal changes, particularly the hormone relaxin, which increases during pregnancy to make ligaments more flexible in preparation for childbirth. As your pregnancy progresses, factors like weight gain, the shifting of your spine to accommodate your baby (lordosis), constipation and water retention can contribute to back pain. Water retention, especially in the third trimester, can also compress soft tissues like those in your wrists, leading to conditions like carpal tunnel syndrome.

Several factors can increase the risk of developing low back and pelvic pain during pregnancy. These include physical, personal, and environmental factors. For a detailed look at these factors, see the table 1 below. Understanding these risk factors can help prevent, manage, and potentially reduce the severity of pain.

Acetaminophen (Tylenol®) During Pregnancy and Brain Development

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Table 1. Risk factors for developing pain during pregnancy.

Risk Factors	Description
Mother Age	Both younger and older maternal age can increase risk.
History of Low Back Pain	Previous back pain, especially if experienced before pregnancy or during menstruation.
Strenuous Work	Engaging in physically demanding tasks.
High Body Mass Index (BMI)	Being overweight or obese can elevate the risk.
Mental Stress and Physical Exhaustion	High levels of stress and fatigue.
Smoking	Smoking is associated with a higher risk of pregnancy-related pain.
Ethnicity	Increased risk noted particularly in Caucasian and African descendant individuals compared to Hispanic individuals.

IMPORTANT: If you are near the end of your pregnancy and notice back pain that radiates to your belly or occurs regularly, it might be the beginning of labor contractions. It’s recommended to contact your healthcare professional to discuss these symptoms and receive guidance on what steps to take next.

2. Why is it important to manage pain during pregnancy?

Feeling some pain during pregnancy is common, especially in the muscles, joints, and back. But it doesn’t mean you should “just live with it”. Untreated pain can make movement difficult, leading to issues like constipation, blood clots, and infections, and can interfere with completing everyday tasks or getting enough rest among others. It can also affect your mental health, increasing the risk of stress, postpartum depression, and long-term pain after birth. Addressing pain helps you feel better, stay active, and improve your quality of life during pregnancy.

Take the time to address any discomfort with your healthcare provider to help prevent these complications and ensure a better quality of life throughout your pregnancy.

Understanding Risks in Pregnancy

Every pregnancy has some natural risk of complications like miscarriages (loss of the baby), premature birth (baby comes before 37 weeks), congenital malformations (birth defects), and other complications. These risks can happen in any pregnancy for many reasons, unrelated to pain or its treatment. This is called the background risk.

Research helps us estimate these risks and compared them with the risks when pain is not managed.

Researchers look at whether pregnancy pain adds to this risk:

So far, studies show that common muscle or joint pain during pregnancy (like back or pelvic pain) does not increase the risk of miscarriage, malformation, or low birth weight.
Some research has found a small increase in the risk of premature birth, but the results are not certain.
There’s also no clear link between pain and long-term health or brain development issues (like autism or ADHD) in children.

That said, it’s important to be careful with how and why pain is treated. Some medications or serious health conditions causing pain may carry risks during pregnancy.

Table 2 show a summary of what research tell us. Remember, these are possible risks, not definite outcomes, and can be influenced by factors like age, genetics, ethnicity, habits (e,g. smoking, alcohol), and other medical conditions.

Table 2: Potential risks linked to unmanaged pain during pregnancy.

Who?	What?	What does research say?
Pregnant person	Miscarriage	No increased risk found.
	Insomnia and Depression	Chronic pain can affect your sleep and mental health.
	Complications from immobility	Increased risks of constipation, blood clots, reduced lung function, and infections.
	Postpartum depression	Some studies found a higher risk of developing postpartum depression.
	Long-term health problems.	Chronic pain during pregnancy might increase the risk of developing chronic pain conditions later in life.
Unborn baby	Premature birth	Acute pain can slightly increased risk of preterm birth (before 37 weeks).
Unborn baby	Congenital malformations	Most research shows no increased risk of congenital malformations.
Future child	Brain development	Pain itself has not been shown to cause problems like autism or ADHD.

3. What can I do to manage pain besides medications?

Before considering medications, there are many helpful and effective ways to manage pain during pregnancy without medical products.

Keeping a pain journal: Write down details so your healthcare provider can understand your pain better. You should include when the pain happens (frequency), where it hurts (location), how strong it is (intensity), what makes it better or worse, and how it affects your daily life.
Stay active and improve posture: Light exercises like walking, yoga, or swimming can help ease back pain and improve overall well-being. Swimming is especially helpful because it takes pressure off your joints and back.
Posture adjustments: Sit up straight with good back support, avoid slumping, wear supportive shoes. Taking regular breaks, resting, and keeping your feet elevated can relieve muscle spasms and acute pain. A back support pillow or a belly band can also help reduce pain by promoting correct body posture.
Complementary techniques: Techniques like TENS (transcutaneous electrical nerve stimulation) where small electrical pulses block pain, or water therapy with gentle exercise can help relief pain for some people.
Prenatal bodywork and therapies: Massage, physiotherapy, osteopathy, chiropractic care, and acupuncture can help reduce pain and improve comfort during pregnancy when done by professionals trained to care for pregnant people.

These strategies can help you feel better and stay active during pregnancy. Always check with your healthcare provider before starting anything new to make sure it’s safe for you and your baby.

4. Medications prescribed for managing pain

If physical activity or other non-medication options aren’t enough to manage nociceptive pain during pregnancy, medications may be needed. The type of medication your healthcare provider recommends will depend on how intense the pain is, how long it lasts, and what is best for you and your baby.

What does research say?

For mild to moderate pain, your pharmacist might recommend over-the-counter (available without prescription) options like:

Acetaminophen (Tylenol®) is usually the first choice. It’s considered safe to use in all trimesters of pregnancy and while breastfeeding, as long as you follow the directions. For more information, see our fact sheet here.

Topical analgesics (pain-relieving creams) like triethanolamine salicylate (e.g., MyoflexMD) may help with sore muscles. This cream acts locally, meaning very little enters the body. Use only a small amount (regular 10% formula) on small areas (like the neck or shoulders), for a short time, and without heat or deep massage.

Some topical products like diclofenac gel (Voltaren®) may be unsafe in certain trimesters. Always check with your healthcare provider before using any cream or gel during pregnancy.

Many other medications are available for pain relief, but should only be use with additional caution:

Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (e.g., Advil, Motrin) are common pain relievers but should be avoided in the first trimester and after 20 weeks, unless approved by your doctor. They may raise the risk of pregnancy complications. Some NSAIDs, like celecoxib (e.g., Celebrex®), are not recommended because we have few research on their safety in pregnancy. Others, like diclofenac-misoprostol (e.g., Arthrotec®), should never be used in due to high risks during pregnancy.

Muscle relaxants like methocarbamol (e.g., Robaxin®) are also not recommended, especially in the second and third trimesters, because of limited research and possible risks. Always speak with your healthcare team before taking any of these medications.

For severe or ongoing pain, your doctor may recommend stronger treatments like corticosteroid injections (e.g., methylprednisolone, triamcinolone) to reduce inflammation, especially for joint or nerve pain like sciatica or severe back pain. In some cases, opioids (e.g., codeine, morphine, oxycodone) may be prescribed if other treatments don’t work. These medications should only be used under close medical supervision, as they carry a risk of dependence and may require special monitoring at birth.

See Table 3 for a list of common pain medications available in Canada. Not all of these medications are recommended during pregnancy. To learn more about a specific medication, consult the associated Fact Sheet. Always discuss with your healthcare provider before starting, stopping, or changing any medication during pregnancy.

Table 3. Some medications available in Canada to treat nociceptive pain.

Medication Types	Medication Names	Brand names
Pain relief (first-line treatment)	Acetaminophen, paracetamol	e.g. Tylenol^®
Non-steroidal anti-inflammatory drugs (NSAIDS) (avoid on 1st trimester and after 20 weeks)	Acetylsalicylic acid	e.g. Aspirine^®
	Ibuprofen	e.g. Advil^®, Motrin^®
	Naproxen	e.g. Aleve^®, Naprosyn^®, Anaprox-DS^®
	Diclofenac	e.g. Voltaren^®
COX-2 selective NSAIDs (Caution needed)	Celecoxib	e.g. Celebrex^®
COX-2 selective NSAIDs (Caution needed)	Meloxicam	e.g. Apo-meloxicam^®
Muscle Relaxants (Few studies)	Cyclobenzaprine	e.g. Flexeril^®
Muscle Relaxants (Few studies)	Methocarbamol	e.g. Robaxin^®, Robaxacet^®
Topic Analgesics (Short use)	Diclofenac in cream	e.g. Voltaren emulgel, Pennsaid
	Methyl salicylate, Menthol, Camphor	e.g. BenGay®, Rub-A535
	Triethanolamine salicylate	e.g. Myoflex®

*These medications are not all recommended during pregnancy. Always talk to your doctor before making changes.

What about nerve-related pain?

For nerve-related pain (neuropathic pain), such as burning, tingling, or shooting pain, doctors may sometimes prescribe:

Anti-seizure medications like gabapentin (Neurontin®), pregabalin (Lyrica®), or carbamazepine (Tegretol®)

Tricyclic antidepressants such as amitriptyline (Elavil®) or nortriptyline (Aventyl®)

Serotonin-norepinephrine reuptake inhibitor (SNRIs) like duloxetine (Cymbalta®) or venlafaxine (Effexor®)

These medications are generally used with caution during pregnancy and only when needed. Always speak with your healthcare provider before starting or continuing any of these medications.

How do I know which one to take?

Every medication has benefits and risks. Your healthcare team is the best source of advice. They can guide you in making an informed decision and find the safest and most effective treatment for you and your baby.

Some medications, like acetaminophen (Tylenol^®), cyclobenzaprine, codeine, morphine, and triethanolamine salicylate (like Myoflex^®), are often preferred during pregnancy. These options have been more carefully studied, so we know more about their safety. But if they don’t help enough, your doctor may suggest other options. Other options can be offered to you while breatfeeding or chestfeeding.

Always talk to your pharmacist, nurse, doctor, or midwife if your current treatment isn’t working, the pain persists, or the side effects are interfering with your daily activity.

It’s important to avoid self-medication. Using substances like cannabis for pain relief during pregnancy or breastfeeding/ chestfeeding can increase risk for you and your baby.

If you’re unsure about your treatment or have questions, it’s best to discuss them your healthcare team. They can help you look at the benefits of your medications and any possible risks. Whether you talk to a pharmacist, nurse, physician, or midwife, they are there to support you and help you make an informed decision for your health and your baby’s health.

5. What about pain while breastfeeding or chestfeeding?

Sometimes, breastfeeding or chestfeeding can cause nipple, breast or abdominal pain, especially in the early postpartum period. This pain is usually temporary. For example, breastfeeding/ chestfeeding can induce contraction of the uterus, which may lead to abdominal pain soon after birth.

But, if you choose to breastfeed or chestfeed and pain or discomfort lasts or becomes hard to manage, it’s important to speak up. Ongoing pain can affect your well-being and make it harder to continue feeding your baby. Breastfeeding or chestfeeding should be as comfortable as possible, chronic or long-term pain is not something you should have to live with.

If needed, some medication like acetaminophen (Tylenol^®) can be safely used during breastfeeding or chestfeeding to help manage pain. Your healthcare professional can help you find the best option for you and your baby.

Don’t hesitate to ask your questions on breastfeeding or chestfeeding to your healthcare professional (doctor, nurse, pharmacist) or a lactation consultant from your region (e.g. Canadian Lactation Consultant Association).

Key Takeaways

New pain such as back and pelvic pain can arise during pregnancy due to hormonal changes, weight gain, and posture shifts.
It’s essential to treat pain during pregnancy to prevent complications like postpartum depression and long-term health issues.
Non-medication approaches include physical activity, posture adjustments, and complementary techniques.
Some medications like acetaminophen can be taken during pregnancy to help, but always consult your healthcare provider before taking any medication.
Breastfeeding or chestfeeding pain should be addressed with professional help.
Working with your healthcare team helps you make the best choices, monitor your health, and adjust your treatment as needed to have a healthy pregnancy while managing your pain.

Research Is Great, But It Is Not Perfect

Making informed health decisions during pregnancy also means understanding what research can tell us and what it can’t. Here’s what our experts have found about the limits of studies on pain during pregnancy:

Fewer participants: Many people don’t join studies during pregnancy because of safety concerns. This means studies are smaller and may not represent everyone.
Variability in pain: Everyone feels pain differently. That makes it hard for researchers to compare results between people or studies.
Many possible causes: Pain during pregnancy can happen for different reasons like posture changes, nerve pressure, or other health issues. This makes it hard to know if the risks come from the pain itself or from the condition causing it.
Pregnancy is complicated: Many things happen in pregnancy at once, like nausea, back pain, or stress. This makes it hard to study pain by itself.
Not always reported: Some people may not talk about their pain, especially if they think it’s “normal” or worry about being judged. This means the research may miss important information.
Researchers are learning more every year, but there’s still a lot we don’t know. That’s why your experience matters, personalized care is important, and asking questions and staying informed helps you make the best choices for you and your baby.

Other online resources

Your Guide to a Healthy Pregnancy – Public Health Agency of Canada:
Your Guide to a Healthy Pregnancy – Canada.ca
https://www.canada.ca/en/public-health/services/pregnancy/healthy-pregnancy-guide.html
Labour and Delivery: Coping with Pain – INSPQ:
Labour and Delivery: Coping with Pain | Institut national de santé publique du Québec (inspq.qc.ca)
https://www.inspq.qc.ca/en/publications/3052
Pain Medications – INSPQ:
Pain Medications | Institut national de santé publique du Québec (inspq.qc.ca)
https://www.inspq.qc.ca/en/publications/3022
INSPQ – Pain while Breastfeeding:
Common Breastfeeding Difficulties | Institut national de santé publique du Québec (inspq.qc.ca)
https://www.inspq.qc.ca/en/publications/2345
CHU Sainte-Justine – Small Guide to Pregnancy and Breastfeeding:
Petit guide: Pregnancy and Breastfeeding – CHU Sainte-Justine (PDF)
https://www.chusj.org/getmedia/yourguide-protege.pdf.aspx

References

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Fiat, Felicia, Merghes, Petru, Scurtu, Alexandra, Guta, B. Almajan, Dehelean, Cristina, Varan, Narcis, and Bernad, Elena. “The Main Changes in Pregnancy—Therapeutic Approach to Musculoskeletal Pain”. Medicina, 58, 8, MDPI AG (2022)
Holdcroft, Anita et al. “Pain and uterine contractions during breast feeding in the immediate post-partum period increase with parity.” Pain vol. 104,3 (2003): 589-596. doi:10.1016/S0304-3959(03)00116-7
Fitzgerald E, Parent C, Kee MZL, Meaney MJ. Maternal Distress and Offspring Neurodevelopment: Challenges and Opportunities for Pre-clinical Research Models. Front Hum Neurosci. 2021 Feb 12;15:635304. doi: 10.3389/fnhum.2021.635304. PMID: 33643013; PMCID: PMC7907173.
Madadi, P., Avard, D., & Koren, G. (2012). Pharmacogenetics of Opioids for the Treatment of Acute Maternal Pain During Pregnancy and Lactation. Current Drug Metabolism, 13(6), 721–727. doi:10.2174/138920012800840392
Mo, Jian-Lan, Ning, Zhipeng, Wang, Xiaoxia, Li, Feng, Feng, Jifeng, and Pan, Linghui. “Association between perinatal pain and postpartum depression: A systematic review and meta-analysis”. Journal of Affective Disorders, 312, , Elsevier BV (2022)
Lan, Qianwen, et al. “The Association between Musculoskeletal Pain during Pregnancy and Pregnancy Outcomes: A Systematic Review and Meta-Analyses.” European Journal of Obstetrics & Gynecology and Reproductive Biology, vol. 294, 2024, pp. 180–190. Elsevier, https://doi.org/10.1016/j.ejogrb.2024.01.027.
Ray-Griffith, Shona, Wendel, Michael, Stowe, Zachary N., and Magann, Everett F.. “Chronic pain during pregnancy: a review of the literature”. International Journal of Women’s Health, Volume 10, , Informa UK Limited (2018)
Ribeiro, Maria Margarida, Andrade, Alejandra, and Nunes, Inês. “Physical exercise in pregnancy: benefits, risks and prescription”. Journal of Perinatal Medicine, 50, 1, Walter de Gruyter GmbH (2021)
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Mu A, Weinberg E, Moulin D. E, Clarke H. Pharmacologic management of chronic neuropathic pain. Review of the Canadian Pain Society consensus statement. Accessed on 17 April 2025 : https://www.cfp.ca/content/cfp/63/11/844.full.pdf
Steroid Injection. Accessed on 17 April 2025 : https://arthritis.ca/treatment/medication/medication-reference-guide/medications/steroid-injection

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