Tamura Shoran, Vardhan Swarnima, Breidenbach Kathryn, Shaparin Naum, Vydyanathan Amaresh, Gritsenko Karina
Department of Anesthesiology, Columbia University, New York, NY, USA.
Department of Anesthesiology, Yale New Haven Health/Bridgeport Hospital, Bridgeport, CT, USA.
J Pain Res. 2025 May 21;18:2605-2612. doi: 10.2147/JPR.S510703. eCollection 2025.
Women of childbearing age often require a nuanced and individualized approach to chronic pain management, especially when pregnancy is a possibility. Interventional procedures involving ionizing radiation, such as fluoroscopy-guided injections, raise specific concerns for fetal safety, including risks of embryo death, congenital anomalies, intellectual disability, and microcephaly. Despite national recommendations from organizations like the American College of Radiology (ACR), implementation of pregnancy screening in the pain management context remains limited.
This review synthesizes current literature and practice guidelines to assess the gaps in pregnancy screening protocols within chronic pain management settings. It highlights challenges in evaluating pregnancy status before initiating pharmacologic or fluoroscopic procedures, and it examines both biological testing limitations and procedural risks.
Fluoroscopically guided procedures may exceed the teratogenic radiation threshold of 50 mGy, underscoring the critical need for reliable pregnancy screening. While urine and serum hCG tests are widely used, both are susceptible to false negatives and positives due to timing, hormone variants, and analytical interferences. Integrating clinical evaluation with menstrual history, point-of-care testing, and serum confirmation may improve diagnostic accuracy and ensure greater protection for the fetus.
To address safety concerns, this review proposes a structured pregnancy screening algorithm tailored for chronic pain practices. Key recommendations include: routine screening of all reproductive-age women prior to procedures involving radiation or teratogenic medications, use of serum hCG testing when uncertainty exists, optimizing radiation exposure strategies, and clear, informed consent processes outlining fetal risks. Adoption of these best practices may improve clinical consistency and enhance patient safety.
育龄女性在慢性疼痛管理方面通常需要细致入微且个性化的方法，尤其是在存在怀孕可能性的情况下。涉及电离辐射的介入性操作，如荧光透视引导下的注射，引发了对胎儿安全的特殊担忧，包括胚胎死亡、先天性异常、智力残疾和小头畸形的风险。尽管美国放射学会（ACR）等组织给出了全国性建议，但在疼痛管理背景下进行妊娠筛查的实施情况仍然有限。
本综述综合了当前的文献和实践指南，以评估慢性疼痛管理环境中妊娠筛查方案的差距。它突出了在开始药物或荧光透视检查之前评估妊娠状态的挑战，并审视了生物学检测的局限性和操作风险。
荧光透视引导下的操作可能超过50毫戈瑞的致畸辐射阈值，这凸显了可靠妊娠筛查的迫切需求。虽然尿液和血清人绒毛膜促性腺激素（hCG）检测被广泛使用，但由于检测时间、激素变体和分析干扰，这两种检测都容易出现假阴性和假阳性。将临床评估与月经史、即时检测和血清确认相结合，可能会提高诊断准确性，并确保为胎儿提供更大的保护。
为了解决安全问题，本综述提出了一种为慢性疼痛治疗量身定制的结构化妊娠筛查算法。主要建议包括：在进行涉及辐射或致畸药物的操作之前，对所有育龄女性进行常规筛查；在存在不确定性时使用血清hCG检测；优化辐射暴露策略；以及制定清晰、知情的同意程序，概述胎儿风险。采用这些最佳实践可能会提高临床一致性并增强患者安全。
