Navigating Pregnancy Testing in Chronic Pain Management for Women of Reproductive Age

Background: 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. Methods: 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. Results: 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. Conclusion and Recommendations: 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.