On-call scenario 6: Introduction

Last updated: Tuesday, November 26, 2019

Scenario 6
"Hi. Can I get some advice about managing a patient in A&E with neuropathic pain? She's pregnant, and I just want to make sure there's something we can use that's safe."

As usual you'll begin by asking four questions to get the basic background info needed. This is what you find out...

Caller: Eve Wood, bleep 9943, specialist pain nurse.

Patient: Chloe Diaz, 40 years old.

Medicines: Sertraline 50mg OM. No known drug allergies.

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Clinical problem: Patient has attended the Emergency Department with severe neck and arm pain. Team are investigating the cause but suspect it might be nerve impingement. Patient is 35 weeks pregnant and pregnancy is progressing uneventfully; she has received codeine and tramadol via her GP but to no effect. Specialist nurse thinking about advising use of neuropathic agents; she would prefer pregabalin but might also consider gabapentin.

Where could you look for more information?
It's helpful that you know which medicine Eve would prefer to use, as this narrows down your search for information on safety in pregnancy. Sometimes a question about safe prescribing in pregnancy can wait until the next working day for you to seek expert advice. However, in this instance where the pain was so severe that the patient attended A&E, you decide to start to investigate the problem. Think about where you would look in this situation, then click Next Page to see our ideas.